South Carolina RN Managed Care Coordinator

Job Summary

To support healthcare management, the full-time remote South Carolina RN Managed Care Coordinator will review and evaluate medical or behavioral eligibility for benefits, applying clinical expertise and administrative policies to service requests while promoting quality and cost-effective outcomes.

Key responsibilities

• Perform medical or behavioral review/authorization processes to ensure coverage for appropriate services within benefit and medical necessity guidelines
• Utilize allocated resources to support review determinations and identify referrals to appropriate staff while ensuring compliance with applicable regulations
• Provide patient education regarding the healthcare delivery system and promote enrollment in care management programs

Required qualifications

• Associate degree in a job-related field or graduate of an accredited school of nursing
• Two years of clinical experience
• Active, unrestricted RN licensure in the state of hire or active compact multistate unrestricted RN license
• Proficiency in Microsoft Office software
• Ability to work independently and prioritize effectively