South Carolina RN Managed Care Coordinator

Job Summary

A company is looking for a RN Managed Care Coordinator I (Utilization Management).

Key Responsibilities

• Perform medical or behavioral review/authorization processes to ensure service coverage meets eligibility and medical necessity guidelines
• Utilize resources to support review determinations and coordinate referrals to appropriate staff while ensuring compliance with regulatory guidelines
• Provide education to members and providers about the healthcare delivery system and promote enrollment in care management programs

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 and Microsoft Office
• Ability to work independently and prioritize effectively