Remote RN - Care Coordination & Utilization Review

CEI; Columbia (SC); Remote; USD 43,000 - 62,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) match

Job summary

CEI is seeking an RN/Managed Care Coordinator in Columbia, SC. Position is primarily remote after an initial onsite training period, with at least 4 weeks on-site orientation.

You will review eligibility for benefits, support members through case management, and coordinate care across the healthcare continuum. Requires SC RN license and critical care experience; W2 contract with benefits optional.

Qualifications

• Active, unrestricted RN license in South Carolina.
• Critical care experience in ICU/ER/PACU or step-down units.
• Utilization Management/Utilization Review experience.
• Case management experience.

Responsibilities

• Conduct medical/behavioral benefit eligibility and medical-necessity reviews.
• Perform active case management including assessment, care planning and coordination.
• Support members telephonically with chronic or high-risk conditions.
• Complete authorization and utilization review activities.
• Document clinical rationale and supporting information for determinations.
• Coordinate with providers and members regarding care delivery and benefits.
• Maintain knowledge of contract benefits and network status.

Skills

RN licensure SC

Critical care exp

Utilization Mgmt

Care management

Appeals workflows

Medicare knowledge

Multi-system docs

Education

Associate Degree in Nursing

Bachelor's in Nursing (preferred)

Tools

Outlook

Teams

Excel

Job description

CEI is seeking an RN/Managed Care Coordinator in Columbia, SC. Position is primarily remote after an initial onsite training period, with at least 4 weeks on-site orientation.

You will review eligibility for benefits, support members through case management, and coordinate care across the healthcare continuum. Requires SC RN license and critical care experience; W2 contract with benefits optional.