Remote LPN Utilization Management Coordinator

Southcarolinablues; South Carolina; Remote; USD 62,000 - 78,000; Full time

Benefits offered by this job

Health benefits

401k with match

Life Insurance

PTO

Education assistance

Employee discounts

Job summary

BlueCross BlueShield of South Carolina is seeking an LPN Utilization Management Coordinator I to join our team. This full-time role focuses on medical surgical/pharmacy reviews and UM activities within the LPN/LBSW scope, with remote work from home in South Carolina.

You'll document decisions per guidelines, support claims review, and educate members and providers on coverage determinations. On-site trainings may occur occasionally; sponsorship is not available.

Qualifications

• Bachelor's in a related field or equivalent.
• Active LPN/LVN license in the state hired.
• 2 years of LPN or LBSW experience requested.
• Ability to handle confidential information with discretion.
• Proficient with Microsoft Office and typing.

Responsibilities

• Handle authorization to ensure benefit coverage per UM guidelines.
• Review interdepartmental requests and medical information timely.
• Educate members and providers on reviews and determinations.
• Support discharge planning with Managed Care Coordinators.

Skills

Word processing

Customer service

Analytical thinking

Organizational skills

Written communication

Typing

Discretion

Presentation skills

Education

Bachelor's degree in a job-related field

Active LPN/LVN licensure in US

Tools

Microsoft Office

Excel

Access

Job description

BlueCross BlueShield of South Carolina is seeking an LPN Utilization Management Coordinator I to join our team. This full-time role focuses on medical surgical/pharmacy reviews and UM activities within the LPN/LBSW scope, with remote work from home in South Carolina.

You'll document decisions per guidelines, support claims review, and educate members and providers on coverage determinations. On-site trainings may occur occasionally; sponsorship is not available.