Remote LPN Utilization Management Coordinator I

Southcarolinablues; Northern (KY, SC); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance PTO

On-site cafeterias and fitness centers

Education Assistance Service Recognitn

Job summary

BlueCross BlueShield of South Carolina is hiring a Utilization Management Coordinator I. You will perform medical, surgical, and pharmacy reviews, applying established criteria to determine medical necessity and benefit coverage.

The role supports UM processes, documentation, and education for members and providers. The position is full-time, remote in South Carolina, with responsibilities spanning education, review, and collaboration across care teams.

Qualifications

• Bachelor's degree in a job-related field is required.
• Active LPN/LVN license in the state of hire or an active compact multistate LPN license.
• 2 years of experience as LPN or LBSW is required.
• Working knowledge of word processing software and MS Office.
• Good judgment, strong communication, and customer service skills.

Responsibilities

• Perform utilization management reviews using established guidelines.
• Determine eligibility, benefits level, and medical necessity of services.
• Educate members, families, and providers on UM processes and terms.
• Back up review determinations with documentation and rationale.
• Support discharge planning and collaborate with Care Coordinators.

Skills

Word processing software

Analytical thinking

Customer service

Communication skills

Typing skills

Education

Bachelor's degree in a job-related field

LPN/LVN licensure or LBSW

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is hiring a Utilization Management Coordinator I. You will perform medical, surgical, and pharmacy reviews, applying established criteria to determine medical necessity and benefit coverage.

The role supports UM processes, documentation, and education for members and providers. The position is full-time, remote in South Carolina, with responsibilities spanning education, review, and collaboration across care teams.