Remote Health Case Manager & Care Coordinator

Southcarolinablues; Columbia (SC); Híbrido; USD 34.000 - 41.000; Jornada completa

Descripción de la vacante

BlueCross BlueShield of South Carolina is seeking a Case Management Coordinator to join our team in Columbia. The role starts with onsite training at the Percival Road office for one week, then transitions to remote work as the employee remains within 2 hours of Columbia, SC.

The position requires an RN license or related advanced degree, with 4+ years of clinical or utilization review experience. Responsibilities include case management, clinical reviews, and member education to promote

Formación

• Experience in clinical case management or utilization review.
• Knowledge of healthcare contracts and regulations (ERISA, URAC, NCQA).
• Ability to document clinical information for medical necessity criteria.

Responsabilidades

• Case manage and coordinate health services for members; develop action plans with members.
• Provide telephonic support to members with chronic conditions.
• Perform medical/behavioral review and authorization within guidelines.
• Document clinical information for claims adjudication and compliance.
• Assist with data collection/input for system workflows and reporting.
• Maintain knowledge of contracts and network status; respond to inquiries.

Conocimientos

Word processing

Quality improvement

Contract language

Independent work

Decision making

Customer service

Communication

Analytical thinking

Educación

Associate Degree - Nursing

Graduate of Accredited School of Nursing

Master’s degree in Social Work or Psychology or Counseling

Herramientas

Microsoft Office

Excel

Access

Descripción del empleo

BlueCross BlueShield of South Carolina is seeking a Case Management Coordinator to join our team in Columbia. The role starts with onsite training at the Percival Road office for one week, then transitions to remote work as the employee remains within 2 hours of Columbia, SC.

The position requires an RN license or related advanced degree, with 4+ years of clinical or utilization review experience. Responsibilities include case management, clinical reviews, and member education to promote