South Carolina RN Managed Care Coordinator

Job Summary

To support health management initiatives, the full-time remote South Carolina RN Managed Care Coordinator will evaluate medical and behavioral eligibility for benefits, coordinate care plans, and provide patient education to ensure quality outcomes.

Key responsibilities

• Perform medical or behavioral review/authorization processes to ensure service coverage aligns with benefit and medical necessity guidelines
• Utilize resources to support review determinations and make referrals to appropriate staff for comprehensive care management
• Educate members and providers on the healthcare delivery system and promote enrollment in care management programs

Required qualifications

• Associate's 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 compact multistate license
• Working knowledge of Microsoft Office software
• Ability to handle confidential information with discretion