Remote RN: Managed Care Coordinator

Southcarolinablues; Columbia (SC); Remote; USD 29,000 - 41,000; Full time

Job summary

BlueCross BlueShield of South Carolina (BCBSSC) is seeking a Coordinator, Managed Care I for a remote role. The position requires an active SC RN license, at least 2 years of clinical experience, and strong communication skills.

Training begins onsite for the first week with subsequent remote work allowed. The role emphasizes medical necessity reviews, provider education, and collaboration with medical directors.

Qualifications

• Active, unrestricted RN license valid in South Carolina, including multistate compact.
• Minimum 2 years of clinical experience.
• Strong computer proficiency.
• Ability to read, understand, and interpret clinical information and medical policies.
• Strong written and verbal communication skills.
• Ability to work independently and prioritize effectively.
• Strong organizational and customer service skills.
• Sound judgment and decision-making skills.
• Excellent analytical and critical thinking abilities.
• Ability to maintain confidentiality.

Responsibilities

• Performs medical or behavioral review and authorization processes. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Assesses service needs, develops action plans, evaluates outcomes, and coordinates discharge planning or alternate treatment plans.
• Utilizes available resources to support review determinations. Makes referrals to Medical Directors, Case Managers, and other departments; ensures compliance with ERISA, NCQA, URAC, DOI, DOL, etc.
• Participates in member and provider education regarding healthcare delivery systems, benefit plans, and network utilization; promotes enrollment in care management and disease management programs.
• Maintains current knowledge of provider contracts and network status; assists with claims discussions, resolutions, and referrals to appropriate internal departments.
• Provides written and verbal communication to healthcare providers and members regarding requested services.

Skills

RN license

Clinical experience

Computer proficiency

Communication skills

Independent work

Organizational skills

Analytical thinking

Confidentiality

Judgment

Clinical policy interpretation

Education

Associate degree in nursing

Graduate of Accredited School of Nursing

Bachelor's degree in Nursing

Tools

Microsoft Office Suite

Microsoft Excel

Microsoft Access

Job description

BlueCross BlueShield of South Carolina (BCBSSC) is seeking a Coordinator, Managed Care I for a remote role. The position requires an active SC RN license, at least 2 years of clinical experience, and strong communication skills.

Training begins onsite for the first week with subsequent remote work allowed. The role emphasizes medical necessity reviews, provider education, and collaboration with medical directors.