RN/Managed Care Coordinator - Remote

CEI; Columbia (SC); Remote; USD 43,000 - 62,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) match

Job summary

CEI is seeking an RN/Managed Care Coordinator in Columbia, SC. Position is primarily remote after an initial onsite training period, with at least 4 weeks on-site orientation.

You will review eligibility for benefits, support members through case management, and coordinate care across the healthcare continuum. Requires SC RN license and critical care experience; W2 contract with benefits optional.

Qualifications

• Active, unrestricted RN license in South Carolina.
• Critical care experience in ICU/ER/PACU or step-down units.
• Utilization Management/Utilization Review experience.
• Case management experience.

Responsibilities

• Conduct medical/behavioral benefit eligibility and medical-necessity reviews.
• Perform active case management including assessment, care planning and coordination.
• Support members telephonically with chronic or high-risk conditions.
• Complete authorization and utilization review activities.
• Document clinical rationale and supporting information for determinations.
• Coordinate with providers and members regarding care delivery and benefits.
• Maintain knowledge of contract benefits and network status.

Skills

RN licensure SC

Critical care exp

Utilization Mgmt

Care management

Appeals workflows

Medicare knowledge

Multi-system docs

Education

Associate Degree in Nursing

Bachelor's in Nursing (preferred)

Tools

Outlook

Teams

Excel

Job description

RN/Managed Care Coordinator

Job at a Glance

• Title:RN/Managed Care Coordinator
• Location: Columbia, SC (primarily remote after training; initial onsite orientation expected for at least 4 weeks)
• Contract: W2 only
• Pay: $38/hour andoptional medical, dental, vision, 401(k) match
• Must live in South Carolina
• Must have an active, unrestricted RN license in the state of South Carolina
• APPLICANTS MUST HAVE ANY OF THE FOLLOWING EXPERIENCE TO BE CONSIDERED FOR THE POSITION, CRITICAL CARE EXPERIENCE, ICU, ER, cardiac PACU, Progressive care unit or Step-down units

Overview

This role reviews and evaluates medical or behavioral eligibility for benefits by applying clinical criteria, administrative policy, and clinical judgment to service requests. You will support members through case management and care coordination, helping ensure appropriate, cost-effective outcomes across the healthcare continuum. The position is primarily remote following an initial onsite training period.

Key Responsibilities

• Conduct medical/behavioral benefit eligibility and medical-necessity reviews using established criteria and policy.
• Perform active case management, including assessment, care planning, coordination, monitoring, and outcome evaluation.
• Support members telephonically with chronic, acute, or high-risk conditions through assessment, education, and coaching.
• Complete authorization and utilization review activities and route complex cases to appropriate clinical stakeholders.
• Document clinical rationale and supporting information to ensure accurate determinations and continuity of care.
• Coordinate with providers and members regarding care delivery, benefits, and appropriate utilization.
• Maintain working knowledge of contract benefits and network/provider status as applicable to reviews.

Required Skills

• Active, unrestricted RN license in South Carolina (or compact multistate RN license recognized for the state of hire, as applicable).
• Clinical experience in critical care settings (e.g., ICU, ER, PACU/cardiac PACU, progressive care, step-down).
• Utilization Management / Utilization Review and medical necessity determination experience.
• Case management / care management experience.
• Experience with appeals and reconsideration workflows (preferred).
• Experience supporting Medicare populations and/or working within a health insurance environment.
• Ability to navigate and document across multiple systems concurrently (including Microsoft Outlook, Teams, and Excel).
• Knowledge of healthcare quality and regulatory frameworks as applicable (e.g., NCQA, URAC, ERISA).

Education

• Associate Degree in Nursing (or graduate of an accredited school of nursing) required.
• Bachelor’s degree in Nursing preferred.

Preferred Skills

• Additional clinical experience in specialty areas such as oncology, cardiology, neonatology, maternity, rehabilitation, mental health/chemical dependency, orthopedics, or general medicine/surgery.
• Prior experience in a health plan environment performing authorization, utilization review, and/or care management activities.
• Case management and/or clinical specialty certification (if applicable to your background).
• Availability for periodic on-call rotation following completion of training.

Why Should I Apply?

This opportunity offers a pathway into a structured care management environment where clinical expertise directly supports member outcomes and appropriate utilization of services. If you thrive in clinical decision-making and coordinated care, this role provides meaningful impact and growth.

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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