RN/Managed Care Coordinator - Remote

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

Back RN/Managed Care Coordinator - Remote
Healthcare Columbia , South Carolina Contract Hybrid Oct 30, 2026

RN/Managed Care Coordinator

Job at a Glance

• Title: Managed Care Coordinator/RN
• Location: Columbia, SC (training onsite for at least 4 weeks; once complete, then remote
• Contract: W2 only
• Pay: $34/hour + optional medical, dental, vision, 401(k) match
• Must live within 2 hours of Columbia, SC
• Must have an active, unrestricted RN license in the state of South Carolina

Overview

This role supports utilization management activities by reviewing medical or behavioral health service requests against clinical criteria and benefit guidelines. You will help ensure timely, accurate authorization decisions while coordinating with providers and internal clinical partners to promote quality and cost-effective outcomes.

Key Responsibilities

• 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

Required Skills

• 4+ years clinical RN experience
• Strong clinical documentation skills and clinical decision-making ability
• Knowledge of medical necessity criteria and benefit interpretation
• Proficiency with Microsoft Office tools (Word; Excel and database/spreadsheet tools)

Education

• Associate Degree in Nursing, or graduate of an accredited school of nursing
• Active, unrestricted clinical license in the state of hire (RN multistate compact acceptable;

Preferred Skills

• Behavioral Health experience
• Infusion therapy experience
• Program management experience in a healthcare setting
• Case Manager Certification and/or clinical specialty certification
• Familiarity with quality improvement processes and contract language interpretation

Why Should I Apply?

Join a fast-paced clinical review environment where your expertise directly impacts member outcomes and access to appropriate care.

About CEI:

As a trusted technology partner, CEI delivers solutions that help our customers transform their business and achieve meaningful results. From strategy and custom application development through application management - our technology and digital experience services are tailored to meet each unique need of our customers. Our staffing solutions bring specialized skills to complement our customers' workforce and project requirements.
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