RN/Managed Care Coordinator - Remote

RN/Managed Care Coordinator Job at a Glance Title: RN/Managed Care Coordinator Location: Columbia, SC (primarily remote after training; initial onsite orientation expected for at least 4 weeks) Contract: W2 only Pay: $38/hour andoptional medical, dental, vision, 401(k) match Must live in South Carolina Must have an active, unrestricted RN license in the state of South Carolina APPLICANTS MUST HAVE ANY OF THE FOLLOWING EXPERIENCE TO BE CONSIDERED FOR THE POSITION, CRITICAL CARE EXPERIENCE, ICU, ER, cardiac PACU, Progressive care unit or Step-down units Overview This role reviews and evaluates medical or behavioral eligibility for benefits by applying clinical criteria, administrative policy, and clinical judgment to service requests. You will support members through case management and care coordination, helping ensure appropriate, cost-effective outcomes across the healthcare continuum. The position is primarily remote following an initial onsite training period. Key Responsibilities Conduct medical/behavioral benefit eligibility and medical-necessity reviews using established criteria and policy. Perform active case management, including assessment, care planning, coordination, monitoring, and outcome evaluation. Support members telephonically with chronic, acute, or high-risk conditions through assessment, education, and coaching. Complete authorization and utilization review activities and route complex cases to appropriate clinical stakeholders. Document clinical rationale and supporting information to ensure accurate determinations and continuity of care. Coordinate with providers and members regarding care delivery, benefits, and appropriate utilization. Maintain working knowledge of contract benefits and network/provider status as applicable to reviews. Required Skills Active, unrestricted RN license in South Carolina (or compact multistate RN license recognized for the state of hire, as applicable). Clinical experience in critical care settings (e.g., ICU, ER, PACU/cardiac PACU, progressive care, step-down). Utilization Management / Utilization Review and medical necessity determination experience. Case management / care management experience. Experience with appeals and reconsideration workflows (preferred). Experience supporting Medicare populations and/or working within a health insurance environment. Ability to navigate and document across multiple systems concurrently (including Microsoft Outlook, Teams, and Excel). Knowledge of healthcare quality and regulatory frameworks as applicable (e.g., NCQA, URAC, ERISA). Education Associate Degree in Nursing (or graduate of an accredited school of nursing) required. Bachelor’s degree in Nursing preferred. Preferred Skills Additional clinical experience in specialty areas such as oncology, cardiology, neonatology, maternity, rehabilitation, mental health/chemical dependency, orthopedics, or general medicine/surgery. Prior experience in a health plan environment performing authorization, utilization review, and/or care management activities. Case management and/or clinical specialty certification (if applicable to your background). Availability for periodic on-call rotation following completion of training. Why Should I Apply? This opportunity offers a pathway into a structured care management environment where clinical expertise directly supports member outcomes and appropriate utilization of services. If you thrive in clinical decision-making and coordinated care, this role provides meaningful impact and growth. 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

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