South Carolina Licensed Managed Care Coordinator

Job Summary

A company is looking for a Managed Care Coordinator I to evaluate medical or behavioral eligibility regarding benefits and clinical criteria.

Key Responsibilities

• Perform medical or behavioral review/authorization processes to ensure coverage within guidelines
• Utilize resources to support review determinations and ensure compliance with regulatory bodies
• Provide patient education and serve as a member advocate regarding healthcare delivery and benefit plans

Required Qualifications, Training, and Education

• Associates degree in a job-related field or equivalent experience
• 2 years of clinical experience
• Active, unrestricted RN licensure or equivalent licensure in social work or counseling
• Working knowledge of word processing software and Microsoft Office
• Ability to work independently and prioritize effectively