Remote Managed Care Coordinator I

ourhrconnect; South Carolina; Hybrid; USD 52,000 - 74,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings with company 4

Life Insurance

Paid Time Off (PTO)

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a Managed Care Coordinator I to review medical and behavioral eligibility by applying clinical criteria and policies. You will coordinate care plans, promote cost-effective outcomes, and support members in managing health conditions.

This full-time remote role requires SC licensure eligibility and strong documentation skills. The position involves ensuring compliant reviews, collaborating with clinical staff, and communicating with providers and

Qualifications

• Associates degree in a related field required.
• Nursing graduate or 2 years related experience accepted.
• 2 years of clinical experience required.
• Working knowledge of word processing software.

Responsibilities

• Reviews medical/behavioral eligibility per benefits and clinical criteria.
• Ensures documentation supports medical necessity and contract benefits.
• Coordinates with Medical Director, Case Manager, and other internal teams.
• Educates members/providers on care delivery systems and network utilization.
• Maintains knowledge of contracts and provider network status.

Skills

clinical criteria

documentation

communication

data entry

Microsoft Office

Education

Associates in a job-related field

Graduate of Accredited School of Nursing or 2 years related experience

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Managed Care Coordinator I to review medical and behavioral eligibility by applying clinical criteria and policies. You will coordinate care plans, promote cost-effective outcomes, and support members in managing health conditions.

This full-time remote role requires SC licensure eligibility and strong documentation skills. The position involves ensuring compliant reviews, collaborating with clinical staff, and communicating with providers and