Remote LPN Utilization Management Coordinator I

001 BlueCross and BlueShield of South Carolina

South Carolina

Hybrid

USD 54,000 - 80,000

Full time

3 days ago

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Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off (PTO)

Education Assistance

Job summary

BlueCross BlueShield of South Carolina is hiring a full‑time LPN Utilization Management Coordinator I for a fully remote role with occasional on‑site trainings. Bachelors in a related field plus LPN/LVN licensure and UM experience are required.

You will review medical/pharmacy services for coverage, determine eligibility and medical necessity, educate members, and support discharge planning with care teams. Strong communication and analytical skills are essential.

Qualifications

Bachelor's in a related field is required.
2 years’ LPN/LBSW experience is required.
Active LPN/LVN license in state of hire or compact multistate license, or active LBSW is required.

Responsibilities

Perform authorization process, ensuring benefit coverage per Utilization Management guidelines.
Review eligibility, level of benefits, and medical necessity of services.
Educate members and families regarding UM processes and implications.
Collaborate with Managed Care Coordinators to support discharge planning.
Respond timely with documentation to members and providers on determinations.