RN/Managed Care Coordinator - Remote

Job Description

Job Description

Job Title
RN/Managed Care Coordinator

Job at a Glance

• Title: Managed Care Coordinator
• Location: Columbia, SC - onsite for the first week for training, then fully remote - must reside within 2 hours of Columbia
• Contract: W2 only
• Pay: $ 31 /hour and optional medical, dental, vision, 401(k) match
• Must have an Active, Unrestricted RN license in the state of South Carolina and a minimum of 2 years clinical RN expereince

Overview
This role involves reviewing inpatient admissions and continued stays across various healthcare facilities, utilizing clinical criteria and policies to assess medical necessity. The position requires collaboration with medical teams, preparation of clinical summaries, and participation in team meetings. Candidates will support health management programs through case review, documentation, and member communication, contributing to quality and cost-effective healthcare outcomes.

Key Responsibilities

• Review inpatient admissions and continued stays for hospitals, skilled nursing, rehabilitation, and LTAC facilities using established criteria and policies.
• Prepare clinical summaries for medical director review when criteria are not met.
• Draft correspondence and coordinate with case management, medical directors, and other healthcare professionals.
• Monitor and evaluate service needs, develop action plans, and ensure compliance with clinical and benefit guidelines.
• Participate in team meetings and ongoing training to maintain proficiency and stay updated on policies.
• Support member education and engagement through telephonic communication, promoting enrollment in care management programs.
• Document clinical information accurately to support medical necessity determinations and claims processing.

Required Skills

• Active RN license (South Carolina or multistate compact) or equivalent clinical licensure.
• Minimum of 2 years of clinical experience, preferably in hospital or utilization review settings.
• Strong knowledge of medical/behavioral review processes and healthcare policies.
• Proficiency in reviewing inpatient and outpatient services using clinical criteria such as Milliman, MCG, or InterQual.
• Excellent communication skills, with the ability to collaborate effectively with healthcare teams.
• Ability to navigate multiple computer systems efficiently and accurately document clinical information.
• Flexibility and proactive communication skills to adapt to changing priorities.
• Experience with claims, coding, and application of contract language is preferred.
• Knowledge of MS Excel, Access, or similar database software is advantageous.

Education

• Associate Degree in Nursing or higher, or equivalent clinical training.
• Active, unrestricted RN license from the US or in the state of hire, or equivalent licensure in social work or counseling.

Preferred Skills

• Bachelor's degree in Nursing or related healthcare field.
• 7+ years of healthcare program management, utilization review, or clinical experience in specialties such as oncology, cardiology, neonatology, or mental health.
• Prior experience with contract language, claims analysis, and healthcare software tools.

Why Should I Apply?
This position offers the opportunity to work within a collaborative healthcare team, supporting critical review processes that impact patient care and resource utilization. It provides a pathway to develop expertise in utilization management and healthcare compliance in a dynamic 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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