Remote LPN Utilization Coordinator I

Santa Barbara Cottage Hospital; United States; Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

401k retirement savings plan

Paid Time Off (PTO)

Health insurance

Education Assistance

Job summary

BlueCross BlueShield of South Carolina is seeking an Utilization Management Coordinator I to perform medical/surgical/pharmacy reviews and manage utilization of services according to established guidelines. The role supports claims review and coordinating with Managed Care across multiple areas.

Responsibilities include education of members and providers, adherence to contractor guidelines, and collaboration with Medical Directors and other departments.

Qualifications

• Bachelor's degree in a related field required.
• Active, unrestricted LPN/LVN licensure in the state hired, or compact multistate LPN license.
• 2 years’ experience as LPN or LBSW.
• Proficient with word processing software.
• Ability to handle confidential information with discretion.
• Strong communication and customer service skills.
• Proficient typing and computer skills.
• Experience with Microsoft Office tools.

Responsibilities

• Perform authorization processes to ensure benefit coverage per UM guidelines.
• Educate members/providers on reviews, coverage determinations, and UM processes.
• Complete required licenses/certificates and coordinate with relevant teams.

Skills

Word processing

Good judgment

Customer service

Analytical thinking

Communication

Typing

Education

Bachelor's degree in a related field

Graduate of Accredited School of LPN/LVN

Tools

Microsoft Office

Microsoft Excel

Job description

BlueCross BlueShield of South Carolina is seeking an Utilization Management Coordinator I to perform medical/surgical/pharmacy reviews and manage utilization of services according to established guidelines. The role supports claims review and coordinating with Managed Care across multiple areas.

Responsibilities include education of members and providers, adherence to contractor guidelines, and collaboration with Medical Directors and other departments.