RN/Managed Care Coordinator (Remote)

Job Description

Job Description

RN/Managed Care Coordinator

Job at a Glance

• Title: Managed Care Coordinator
• Location: Columbia, SC (remote after first week of onsite training; Must live within 2 hours of Columbia)
• Contract: W2 only
• Pay: $ 30/hour and optional medical, dental, vision, 401(k) match
• Must live within 2 hours of Columbia, SC
• Must have an active, Unrestricted RN license in the state of South Carolina
• Must have a minimum of 2 years Clinical RN experience

Overview

This role supports clinical review and coordination activities by evaluating outpatient service requests against established clinical criteria and health plan guidelines. You will manage assigned work queues, document determinations, and collaborate with clinical partners to promote appropriate, cost-effective care.

Key Responsibilities

• Perform clinical review/authorization activities for outpatient service requests using established clinical criteria and benefit guidelines.
• Assess service needs, coordinate action plans, and monitor outcomes related to medical necessity and/or care plan compliance.
• Document clinical rationale and relevant information to support determinations and benefit exceptions.
• Identify needs for escalation and route cases to appropriate clinical resources (e.g., Medical Director, Case Management, Quality).
• Support accurate clinical information flow for downstream processing and related operational needs.
• Communicate determinations and requested-service information to members and providers via written and telephone channels.
• Maintain working knowledge of contract provisions and apply them appropriately to assigned reviews.

Required Skills

• Active, unrestricted Registered Nurse (RN) license in South Carolina or qualifying multistate compact RN license.
• Minimum 2 years of hospital/clinical experience.
• Experience applying clinical criteria to outpatient procedure review and medical necessity determinations.
• Ability to manage multiple case queues, prioritize effectively, and work independently.
• Strong clinical documentation skills with attention to accuracy and completeness.
• Ability to communicate clearly with members and providers by phone and in writing.
• Working knowledge of common word processing software.

Education

• Associate Degree in Nursing or graduate of an accredited school of nursing.
• Bachelor’s degree in Nursing (preferred).

Preferred Skills

• Utilization review/utilization management experience.
• Knowledge of claims and coding analysis processes and requirements.
• Experience coordinating care management, health coaching, or health/disease management interventions.
• Familiarity with applying administrative policies and clinical guidelines within a regulated environment.
• Experience supporting discharge planning and/or alternative treatment planning as appropriate.

Why Should I Apply?

This is an opportunity to use your RN clinical expertise in a structured, remote-friendly environment while contributing to high-quality, medically appropriate care decisions.

About CEI:

As a trusted technology partner, CEI delivers solutions that help our customers transform their business and achieve meaningful results. From strategy and custom application development through application management - our technology and digital experience services are tailored to meet each unique need of our customers. Our staffing solutions bring specialized skills to complement our customers' workforce and project requirements.

#ZR

#INDGEN