South Carolina RN Managed Care Coordinator

Job Summary

As a full-time remote RN Managed Care Coordinator I, the candidate will review and evaluate medical or behavioral eligibility for benefits and clinical criteria, applying clinical expertise and administrative policies to support members in managing their health and care plans.

Key responsibilities

• Perform medical or behavioral review/authorization processes to ensure coverage for appropriate services and evaluate outcomes
• Utilize resources for review determinations and make referrals to appropriate staff while ensuring compliance with regulatory guidelines
• Provide patient education and serve as a member advocate through continued communication and education regarding health care delivery systems

Required qualifications

• Associates degree in a job-related field or equivalent experience from an accredited School of Nursing
• Two years of clinical experience
• Active, unrestricted RN licensure in the state of hire or compact multistate RN license
• Working knowledge of word processing software and Microsoft Office
• Ability to work independently, prioritize effectively, and make sound decisions