Remote RN: Utilization Management Coordinator II

ourhrconnect; United States; Remote; USD 85,000 - 110,000; Full time

Job summary

BlueCross BlueShield of South Carolina is hiring a Managed Care Coordinator II - Utilization Management. The role reviews clinical criteria to determine medical necessity and coordinates care management for members.

The position is full time, remote, with potential on-site trainings. Requires 4 years clinical experience in defined areas or utilization review/case management, plus active US licensure in nursing or related fields.

Qualifications

• Requires Associate's in a related field.
• RN licensure active in US states or LMSW/licensure in relevant fields.
• 4 years clinical or utilization review experience in specified areas.

Responsibilities

• Perform medical/behavioral review and authorization per guidelines.
• Provide discharge planning and assess service needs with providers.
• Communicate with providers and members about requested services.
• Promote care management programs and ensure timely processes.
• Maintain knowledge of contracts and network status of providers.

Skills

Word processing

Quality improvement

Contract language

Independent work

Decision making

Customer service

Oral communication

Written communication

Analytical thinking

Confidential handling

Negotiation skills

Education

Associate's degree

Bachelor's degree (Preferred)

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is hiring a Managed Care Coordinator II - Utilization Management. The role reviews clinical criteria to determine medical necessity and coordinates care management for members.

The position is full time, remote, with potential on-site trainings. Requires 4 years clinical experience in defined areas or utilization review/case management, plus active US licensure in nursing or related fields.