Remote RN: Managed Care Coordinator

CEI; Columbia (SC); Hybrid; USD 34,000 - 49,000; Full time

Benefits offered by this job

Medical/Dental/Vision

401(k) match

Job summary

CEI is seeking an RN/Managed Care Coordinator in Columbia, SC for a remote-friendly role. After a short onsite training period, you will assess outpatient requests against clinical criteria and health plan guidelines, document determinations, and coordinate care with clinicians and members.

The ideal candidate has an active SC RN license, 2+ years of clinical experience, and strong communication skills. This W2 position offers remote work after onboarding and a competitive hourly pay rate.

Qualifications

• Active, unrestricted SC RN license.
• Minimum 2 years hospital/clinical experience.
• Experience applying clinical criteria to outpatient reviews.
• Strong documentation and communication skills.
• Proficiency with MS Word and office software.

Responsibilities

• Perform clinical review/authorization for outpatient requests using criteria and guidelines.
• Assess service needs, coordinate action plans, and monitor medical necessity and care plans.
• Document rationale and information to support determinations and exceptions.
• Escalate cases to Medical Director or Case Management as needed.
• Support accurate clinical information flow for downstream processing.
• Communicate determinations to members and providers by phone and written notes.

Skills

RN license SC

Clinical experience 2y

Outpatient review criteria

Queue management

Documentation

Communication

MS Word / Office

Education

Associate Degree in Nursing

Bachelor’s in Nursing

Tools

Microsoft Word

Job description

CEI is seeking an RN/Managed Care Coordinator in Columbia, SC for a remote-friendly role. After a short onsite training period, you will assess outpatient requests against clinical criteria and health plan guidelines, document determinations, and coordinate care with clinicians and members.

The ideal candidate has an active SC RN license, 2+ years of clinical experience, and strong communication skills. This W2 position offers remote work after onboarding and a competitive hourly pay rate.