Remote LPN Utilization Management Coordinator

001 BlueCross and BlueShield of South Carolina; South Carolina; Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k retirement savings plan with公司匹配

Life Insurance PTO

On-site cafeterias and fitness centers

Education Assistance Service

National discounts to movies, theaters

Job summary

BlueCross BlueShield of South Carolina seeks an Utilization Management Coordinator I to perform medical/pharmacy reviews and manage utilization within LPN/LBSW scope. The role includes documenting decisions, supporting medical claims review, and ensuring compliant UM practices.

The position is full-time, remote in South Carolina, and offers education, training, and benefits as part of a comprehensive package.

Qualifications

• Bachelor's degree or equivalent in a related field.
• Licensed Practical Nursing (LPN) or Licensed Vocational Nursing (LVN) licensure is required.
• 2 years’ working experience as LPN or LBSW.
• Working knowledge of word processing software.
• Strong judgment and decision-making abilities.
• Effective customer service, organizational and presentation skills.
• Analytical or critical thinking abilities.
• Ability to handle confidential information with discretion.
• Typing proficiency and computer literacy.
• Strong oral and written communication skills.
• Microsoft Office proficiency is required.
• Active, unrestricted LPN/LVN licensure or active LBSW in the state hired.

Responsibilities

• Perform authorization and utilization management reviews following guidelines.
• Use allocated resources to back up review determinations.
• Review interdepartmental requests and medical information promptly.
• Determine eligibility, benefits level, and medical necessity of services.
• Educate members and families on medical reviews and UM processes.
• Research to support each determination.
• Support discharge planning and collaborate with care coordinators.
• Communicate documentation to members/providers clearly and timely.
• Maintain up-to-date knowledge of contracts and provider networks.
• Identify referrals to appropriate areas (Medical Director, Subrogation, etc.).

Skills

Word processing

Customer service

Organizational skills

Presentation skills

Analytical thinking

Critical thinking

Discretion/Confidentiality

Typing

Oral and written communication

Education

Bachelor's degree in a job-related field

Graduate of Accredited School of LPN/LVN

Active LPN/LVN licensure (US, state hired) or compact multistate LPN

Active LBSW in state hired

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina seeks an Utilization Management Coordinator I to perform medical/pharmacy reviews and manage utilization within LPN/LBSW scope. The role includes documenting decisions, supporting medical claims review, and ensuring compliant UM practices.

The position is full-time, remote in South Carolina, and offers education, training, and benefits as part of a comprehensive package.