South Carolina Licensed Managed Care Coordinator
Job Summary
To support healthcare services, the full-time South Carolina Licensed Managed Care Coordinator will review and evaluate medical or behavioral eligibility for benefits, utilizing clinical expertise and administrative policies in a fully remote environment.
Key responsibilities
- Perform medical or behavioral review/authorization processes to ensure coverage for services within established guidelines
- Utilize resources to support review determinations and ensure compliance with regulatory bodies
- Provide patient education and serve as a member advocate through ongoing communication regarding healthcare delivery systems
Required qualifications
- Associates degree in a job-related field or equivalent experience
- Active, unrestricted RN licensure or LMSW licensure in the state of hire
- Two years of clinical experience
- Working knowledge of Microsoft Office
- Ability to handle confidential information with discretion
Complete Job Description
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