Remote Managed Care RN – Case Management Specialist

CEI; Columbia (SC); Hybrid; USD 44,000 - 61,000; Full time

Job summary

CEI is seeking a Back RN/Managed Care Coordinator in Columbia, South Carolina. The role is hybrid with onsite work for the first 4–6 weeks, then remote.

You must hold an active, unrestricted SC RN license and have experience in Critical Care, ICU, ER, Cardiac PACU, PCU or step-down units. Responsibilities include case management, clinical reviews for medical necessity, and telephonic member support.

Qualifications

• Active, unrestricted RN license in SC.
• Must live in South Carolina and be able to work onsite in Columbia for 4–6 weeks.
• Experience in Critical Care, ICU, ER, Cardiac PACU, PCU or Step-down units.

Responsibilities

• Reviews and evaluates medical or behavioral eligibility for benefits and clinical criteria.
• Assesses, plans, coordinates, monitors, and evaluates medical necessity and services.
• Provides telephonic support and member-centered coaching.
• Performs case management and develops action plans with members.
• Documents clinical information to support medical necessity criteria and benefits.

Skills

Nursing

Case management

Telephonic support

Motivational interviewing

Education

RN license

Tools

EHR systems

Job description

CEI is seeking a Back RN/Managed Care Coordinator in Columbia, South Carolina. The role is hybrid with onsite work for the first 4–6 weeks, then remote.

You must hold an active, unrestricted SC RN license and have experience in Critical Care, ICU, ER, Cardiac PACU, PCU or step-down units. Responsibilities include case management, clinical reviews for medical necessity, and telephonic member support.