Managed Care Coordinator II/CM-DM (W@H South Carolina)

BlueCross BlueShield of South Carolina; South Carolina; Remote; USD 60,000 - 75,000; Full time

Job summary

A leading healthcare company is seeking a Managed Care Coordinator II to enhance care coordination and improve client outcomes. This remote role involves assessing client needs, developing care plans, and providing education and support to members, particularly those with chronic conditions. The ideal candidate will have clinical experience, proficiency in MS Office, and a passion for improving healthcare delivery.

Benefits

Health Plans

401k

Life Insurance

PTO

Education Assistance

Discounts

Qualifications

• 4 years clinical experience or utilization review/case management.
• 2 years clinical experience required.

Responsibilities

• Active care management and development of care plans.
• Monitoring services and evaluating outcomes.
• Providing telephonic support and education.

Skills

Assessment

Care Coordination

Telephonic Support

Patient Education

Education

Associate's degree in a related field

Bachelor's degree in Nursing

Tools

MS Office

Job description

Managed Care Coordinator II/CM-DM (W@H South Carolina)

Join to apply for the Managed Care Coordinator II/CM-DM (W@H South Carolina) role at BlueCross BlueShield of South Carolina.

Summary

We are hiring a Managed Care Coordinator II to improve care coordination and reduce service fragmentation for recipients, especially across multiple providers and settings. The role aims to enhance client safety, well-being, and quality of life while considering healthcare costs through cost-effective care recommendations. The care manager performs assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy, working closely with clients, families, and healthcare professionals.

Location: This full-time, remote position is Monday-Friday, 8:00am-4:30pm or 8:30am-5:00pm.

Responsibilities include:

• Active care management, assessment, and development of care plans.
• Monitoring services, evaluating outcomes, and ensuring documentation supports medical necessity and benefits.
• Providing telephonic support and education to members, especially those with chronic or high-risk conditions.
• Participating in intervention, patient education, and advocacy activities.
• Performing medical or behavioral review/authorization within benefit and medical necessity guidelines.
• Maintaining knowledge of provider contracts and network status, assisting with claims and referrals.

Minimum qualifications:

• Associate's degree in a related field or equivalent experience, including RN or social worker licensure.
• 4 years recent clinical experience or 4 years utilization review/case management, with at least 2 years clinical.
• Proficiency in MS Office, knowledge of quality improvement, and ability to work independently.

Preferred qualifications:

• Bachelor's degree in Nursing or related field.
• 7+ years healthcare program management experience.
• Additional certifications like Case Manager or clinical specialty certifications.

Benefits include: health plans, 401k, life insurance, PTO, education assistance, and discounts.

We support diversity and inclusion, providing accommodations for individuals with disabilities or religious needs. To apply, submit your resume and follow the next steps as outlined.