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; first week onsite for 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 at least 2 years Clinical RN experience

Overview

This position supports utilization review and authorization activities by reviewing clinical documentation and applying established medical criteria and administrative guidelines. The role partners with internal stakeholders and communicates with providers and members to help ensure appropriate, cost-effective care. This is a remote role for local candidates, with onsite training during the first week.

Key Responsibilities

• Review clinical documentation and evaluate authorization requests using established medical criteria.
• Perform utilization review activities to determine medical necessity, level of care, and length of stay as applicable.
• Coordinate and document care plans and service determinations in accordance with guidelines and policies.
• Communicate with providers and members via written and telephone correspondence regarding service requests and decisions.
• Identify and refer cases to appropriate clinical resources (e.g., Medical Director, Case Management, Quality) when needed.
• Support accurate clinical documentation to enable proper claims adjudication and auditing readiness.
• Maintain compliance with applicable regulatory and accreditation requirements.

Required Skills

• Active, unrestricted Registered Nurse (RN) license (state of hire) OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
• Minimum 2 years of clinical experience.
• Experience reviewing clinical documentation and applying medical necessity criteria.
• Ability to work independently and manage competing priorities in a remote setting.
• Strong written documentation skills and professional telephone communication.

Education

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

Preferred Skills

• Hospital experience.
• Utilization Management / Utilization Review experience.
• Knowledge of claims, coding, analysis, requirements, and related healthcare processes.
• Healthcare program management experience.

Why Should I Apply?

This role offers the opportunity to apply your clinical expertise to support timely, appropriate care decisions while working in a structured, remote environment.

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.

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