Managed Care Coordinator I (South Carolina)

BlueCross BlueShield of South Carolina; Columbia (SC); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading managed care and health insurance organization is offering a fully remote clinical position. This role involves performing medical review processes, evaluating service coverage, and providing education to patients. Candidates should have an Associate's degree and RN licensure, with a strong emphasis on communication and organizational skills.

Benefits

Comprehensive benefits package including health, dental, and vision coverage

401k retirement savings plan with company match

Paid Time Off (PTO) and education assistance

Flexible working hours

Qualifications

• Active, unrestricted RN licensure or LMSW required.
• Minimum of 2 years of clinical experience is necessary.
• Experience in healthcare program management preferred.

Responsibilities

• Perform medical or behavioral review processes for service coverage.
• Evaluate plans' outcomes and provide patient education.
• Communicate effectively with healthcare providers.

Skills

Organizational skills

Customer service

Communication skills

Proficiency in Microsoft Office

Education

Associate's degree in a job-related field

Bachelor's degree in Nursing

Tools

Spreadsheet software

Database software

Job description

Employer Industry: Managed Care and Health Insurance

Why Consider this Job Opportunity:
- Fully remote position with flexible working hours
- Comprehensive benefits package including health, dental, and vision coverage
- 401k retirement savings plan with company match
- Paid Time Off (PTO) and education assistance
- Opportunity to work in a diverse and inclusive environment that promotes career development
- Chance to make a positive impact on members’ health and well-being

What to Expect (Job Responsibilities):
- Perform medical or behavioral review/authorization processes to ensure coverage for appropriate services
- Evaluate outcomes of plans, eligibility, and medical necessity regarding requested services
- Provide patient education regarding healthcare delivery systems and benefits
- Maintain knowledge of contracts and network status of service providers
- Communicate effectively with healthcare providers and members regarding requested services

What is Required (Qualifications):
- Required Education: Associate's degree in a job-related field
- Minimum of 2 years of clinical experience
- Active, unrestricted RN licensure or LMSW from the United States and in the state of hire
- Strong organizational, customer service, and communication skills
- Proficiency in Microsoft Office and ability to handle confidential information

How to Stand Out (Preferred Qualifications):
- Bachelor's degree in Nursing
- Experience in healthcare program management or clinical specialty areas such as oncology or mental health
- Willingness to learn new systems and software
- Knowledge of contract language and claims/coding analysis
- Familiarity with spreadsheet and database software

#ManagedCare #HealthcareJobs #RemoteWork #CareerDevelopment #InclusiveWorkplace

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