South Carolina Licensed Managed Care Coordinator

Job Summary

South Carolina Licensed Managed Care Coordinator, this full-time remote position involves reviewing and evaluating medical or behavioral eligibility for benefits and clinical criteria while utilizing clinical expertise to support members in managing their health.

Key Responsibilities

• Perform medical or behavioral review and authorization processes to ensure coverage for appropriate services
• Utilize resources for review determinations and participate in data collection for clinical information flow
• Provide patient education and maintain knowledge of contracts and network status of service providers

Required Qualifications

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