Remote RN Case Manager, Managed Care II

Southcarolinablues; Columbia (SC); Hybrid; USD 28,000 - 52,000; Part time

Benefits offered by this job

Hybrid/Remote work opportunities

Travel reimbursement for training

Job summary

BlueCross BlueShield of South Carolina is seeking a Coordinator, Managed Care II/CM-DM who will perform active case management and utilization review to support members with chronic or acute illnesses. The role requires an SC RN license and at least four years of clinical or utilization management experience.

Hybrid/remote work opportunities are based on performance, with initial onsite orientation and training. Travel is reimbursed, and occasional on-call duties follow training completion.

Qualifications

• Active South Carolina RN license.

Responsibilities

• Provides active case management, assesses service needs, develops and coordinates action plans, monitors services, and evaluates outcomes.
• Performs medical or behavioral review and authorization processes.
• Participates in direct intervention and education with members and providers regarding healthcare delivery systems, network utilization, and benefit plans.
• Maintains current knowledge of provider contracts and network status; assists with claims information and referrals.
• Provides written and verbal communication regarding requested services to providers and members.
• Conducts comprehensive case management and utilization review activities.
• Assists with training and onboarding as needed.
• Participates in on-call responsibilities after training.

Skills

RN license

Clinical experience

Analytical thinking

Communication

Independent worker

Organizational skills

Education

Associate Degree in Nursing

Graduate of Accredited School of Nursing

Bachelor's Degree in Nursing (preferred)

Tools

Outlook

Microsoft Teams

Microsoft Excel

Microsoft Office Suite

Job description

BlueCross BlueShield of South Carolina is seeking a Coordinator, Managed Care II/CM-DM who will perform active case management and utilization review to support members with chronic or acute illnesses. The role requires an SC RN license and at least four years of clinical or utilization management experience.

Hybrid/remote work opportunities are based on performance, with initial onsite orientation and training. Travel is reimbursed, and occasional on-call duties follow training completion.