South Carolina RN Managed Care Coordinator

Job Summary

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

Key Responsibilities

• Perform medical or behavioral review/authorization processes and ensure compliance with medical necessity guidelines
• Utilize resources for review determinations and assist in data collection for clinical information flow
• Provide patient education and maintain knowledge of contracts and network status of service providers

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 the state of hire
• Working knowledge of word processing software and Microsoft Office
• Ability to work independently and prioritize effectively