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 for appropriate services
• Utilize allocated resources for review determinations and ensure compliance with regulatory guidelines
• Provide patient education and serve as a member advocate through communication and enrollment promotion in care management programs

Required Qualifications, Training, and Education

• Associates in a job-related field or graduate of an accredited school of nursing with 2 years of job-related work experience
• 2 years of clinical experience
• Active, unrestricted RN licensure or equivalent in the state of hire
• Working knowledge of word processing software and Microsoft Office
• Ability to work independently and prioritize effectively