Remote RN: Utilization & Care Coordination

CEI; Columbia (SC); Híbrido; USD 39.000 - 55.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical benefits

Dental benefits

Vision benefits

401(k) match

Descripción de la vacante

CEI is seeking an RN/Managed Care Coordinator in Columbia, SC. The role trains onsite for 4 weeks, then remote work is possible under a hybrid model. W2 contracting with pay of $34/hour plus optional benefits.

Responsibilities include reviewing medical necessity, processing prior authorizations for Medicare Advantage, documenting rationale, coordinating discharge planning, and communicating decisions to providers and members.

Formación

• 4+ years clinical RN experience.
• Knowledge of medical necessity criteria and benefit interpretation.
• Proficiency with Microsoft Office tools (Word; Excel and database/spreadsheet tools).

Responsabilidades

• Review and evaluate service requests for medical necessity and benefit coverage.
• Process prior authorization requests for Medicare Advantage members.
• Document clinical rationale and relevant information to support determinations.
• Coordinate discharge planning and assess service needs with providers/facilities.
• Communicate decisions and next steps with providers and members via phone and written correspondence.
• Escalate complex cases to appropriate clinical resources (e.g., Medical Director, Case Management).
• Support compliance with applicable regulatory and accreditation standards.

Conocimientos

RN experience

Documentation skills

Medical necessity criteria

MS Office

Educación

Associate Degree in Nursing

Nursing graduate

Herramientas

Microsoft Office

Descripción del empleo

CEI is seeking an RN/Managed Care Coordinator in Columbia, SC. The role trains onsite for 4 weeks, then remote work is possible under a hybrid model. W2 contracting with pay of $34/hour plus optional benefits.

Responsibilities include reviewing medical necessity, processing prior authorizations for Medicare Advantage, documenting rationale, coordinating discharge planning, and communicating decisions to providers and members.