Managed Care Coordinator II - CM

BlueCross BlueShield of South Carolina; South Carolina; Remote; USD 55,000 - 75,000; Full time

Job summary

A healthcare insurance company in South Carolina is looking for a Managed Care Coordinator II to enhance care coordination for clients. This role involves active care management, patient education, and the medical review process, requiring a minimum of 4 years of clinical experience and an associate's degree in a related field. This remote position also offers a comprehensive benefits package, including health coverage and a retirement plan.

Benefits

Subsidized health plans

401k retirement savings plan with company match

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Qualifications

• 4 years of recent clinical experience in defined specialty area.
• Graduate of an accredited school of nursing or equivalent experience is required.
• Working knowledge of quality improvement processes required.

Responsibilities

• Provides active care management and assesses service needs.
• Participates in patient education regarding health care delivery.
• Performs medical or behavioral review/authorization process.

Skills

Working knowledge of word processing software

Knowledge of quality improvement processes

Ability to work independently

Education

Associates in a job-related field

Bachelor's degree in Nursing (preferred)

Tools

Spreadsheet software

Database software

Job description

We are currently hiring for a Managed Care Coordinator II to join BlueCross BlueShield of South Carolina. In this role, care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved.

Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care.

The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care.

Location

This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm and will be fully remote. The candidate will be required to report on-site in Columbia, SC, in the first week of their new role.

What You'll Do:

• Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals.
• Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans.
• Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
• Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines.
• Maintains current knowledge of contracts and network status of all service providers and applies appropriately.

To Qualify for This Position, You'll Need the Following:

• Required Education: Associates in a job-related field.
• Degree Equivalency: Graduate of Accredited School of Nursing or 2 years job related work experience.
• Required Experience: 4 years recent clinical in defined specialty area.
• Required Skills and Abilities: Working knowledge of word processing software.
• Knowledge of quality improvement processes and demonstrated ability with these activities.
• Knowledge of contract language and application.
• Ability to work independently, prioritize effectively, and make sound decisions.

We Prefer That You Have the Following:

• Preferred Education: Bachelor's degree in Nursing
• Preferred Work Experience: 7 years-healthcare program management.
• Preferred Skills and Abilities: Working knowledge of spreadsheet, database software.
• Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.

Our Comprehensive Benefits Package Includes the Following:

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status.