Remote RN: Managed Care Coordinator I

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

Job summary

BlueCross BlueShield of South Carolina is seeking a Coordin ator, Managed Care I to review medical and behavioral eligibility, applying clinical criteria to service requests. The role supports care management and ensures medical necessity while coordinating with providers and internal teams.

The position is remote for local candidates with initial onsite training in Columbia, SC, and a fixed start window. Strong RN credentials and 2+ years of clinical experience are required.

Qualifications

• Active, unrestricted RN license valid in the state of hire (SC preferred).
• Minimum 2 years of clinical experience.
• Strong computer proficiency and ability to interpret clinical information.
• Excellent written and verbal communication.
• Ability to work independently with strong organizational skills.
• Ability to maintain confidentiality.

Responsibilities

• Perform medical or behavioral review and authorization within guidelines.
• Coordinate discharge planning and medical necessity determinations.
• Support review determinations and refer to Medical Directors and other departments.
• Educate members and providers about care management and disease programs.
• Maintain compliant documentation and communicate with providers.

Skills

Active SC RN license

Clinical experience 2+ yrs

Computer proficiency

Interpret clinical information

Written and verbal communication

Independent work

Confidentiality

Organizational skills

Analytical thinking

Decision making

Education

Associate Degree in Nursing

Graduate of Accredited School of Nursing

Tools

Microsoft Office Suite

Microsoft Excel

Microsoft Access

Spreadsheet software

Job description

BlueCross BlueShield of South Carolina is seeking a Coordin ator, Managed Care I to review medical and behavioral eligibility, applying clinical criteria to service requests. The role supports care management and ensures medical necessity while coordinating with providers and internal teams.

The position is remote for local candidates with initial onsite training in Columbia, SC, and a fixed start window. Strong RN credentials and 2+ years of clinical experience are required.