Remote RN: Managed Care Coordinator I

BlueCross and BlueShield of South Carolina; United States; Remote; USD 52,000 - 76,000; Full time

Benefits offered by this job

Health plans

401k with company match

Paid Time Off

Education Assistance

Disability and life insurance

Job summary

BlueCross BlueShield of South Carolina is seeking a Managed Care Coordinator I to review medical and behavioral eligibility, applying clinical criteria and policy to service requests. You will promote care management programs and ensure accurate documentation to support care plans and benefits.

The role requires RN or relevant licensure, 2 years of clinical experience, and strong communication skills. This is a full-time, remote position based in South Carolina with standard daytime hours.

Qualifications

• Associates degree in a related field or equivalent experience.
• RN licensure in the U.S. and in-state, or equivalent social work/licensure as applicable.
• 2 years of clinical experience required.
• Proficiency with word processing software and Microsoft Office.

Responsibilities

• Review and authorize medical/behavioral services within benefit and medical necessity guidelines.
• Document clinical information to support medical necessity and benefits decisions.
• Educate members and providers about health care options and care management programs.
• Coordinate with staff for claims processing and care plan updates.

Skills

Word processing

Analytical thinking

Communication skills

Negotiation skills

Education

Associates in a job-related field

Graduate of Accredited School of Nursing or 2 years of job-related work experience

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Managed Care Coordinator I to review medical and behavioral eligibility, applying clinical criteria and policy to service requests. You will promote care management programs and ensure accurate documentation to support care plans and benefits.

The role requires RN or relevant licensure, 2 years of clinical experience, and strong communication skills. This is a full-time, remote position based in South Carolina with standard daytime hours.