Remote Senior Managed Care Coordinator, UM II

Spectraforce Technologies, Inc.; Columbia (SC); Remote; USD 60,000 - 80,000; Full time

Benefits offered by this job

Remote work after training

Onsite training

Travel within community

Job summary

Spectraforce Technologies, Inc. in Columbia, SC is seeking a Managed Care Coordinator UM II to review medical criteria, coordinate care, and support member health through the health management process.

The role begins with four weeks of onsite training, then remote work with a 40-hour Mon–Fri schedule. A strong clinical background and excellent communication are essential for success in this assignment with potential conversion after three months.

Qualifications

• 4 years recent clinical in defined specialty area (oncology, cardiology, neonatology, maternity, rehabilitation, mental health/chemical dependency, orthopedic, general medicine/surgery)
• OR 4 years utilization review/case management/clinical/or combination; 2 of 4 years must be clinical

Responsibilities

• Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria to service requests or health management interventions.
• Assesses, plans, implements, coordinates, monitors, and evaluates medical necessity and services needed to support members’ health.
• Provides discharge planning and assesses service needs with providers and facilities.
• Ensures documentation to support medical necessity criteria and contract benefits.
• Collaborates with Care Management and other areas to ensure timely care management processes.
• Maintains current knowledge of contracts and network status of service providers and applies appropriately.

Skills

Word processing

Quality improvement

Contract language

Independent work

Decision making

Customer service

Communication skills

Spelling and grammar

Oral and written communication

Persuasion/negotiation

Analytical thinking

Confidential information handling

Education

Associate Degree - Nursing or Nursing Diploma

Master's degree in Social Work, Psychology, or Counseling

Bachelor's degree - Nursing

Tools

Microsoft Office

Job description

Spectraforce Technologies, Inc. in Columbia, SC is seeking a Managed Care Coordinator UM II to review medical criteria, coordinate care, and support member health through the health management process.

The role begins with four weeks of onsite training, then remote work with a 40-hour Mon–Fri schedule. A strong clinical background and excellent communication are essential for success in this assignment with potential conversion after three months.