South Carolina Licensed Managed Care Coordinator

A company is looking for a Managed Care Coordinator I to evaluate medical or behavioral eligibility regarding benefits and clinical criteria.

Key Responsibilities

Perform medical or behavioral review / authorization process to ensure coverage for appropriate services

Utilize resources to support review determinations and ensure compliance with regulatory guidelines

Provide patient education and serve as a member advocate for health care delivery and care management programs

Required Qualifications

Associates degree in a job-related field or equivalent experience

2 years of clinical experience

Active, unrestricted RN or LMSW licensure in the state of hire

Working knowledge of word processing software

Ability to work independently and prioritize effectively