South Carolina Licensed Managed Care Coordinator

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

Key Responsibilities

Perform medical or behavioral review / authorization processes and ensure accurate documentation of clinical information

Utilize resources for review determinations and ensure compliance with applicable legislation and guidelines

Provide patient education and maintain knowledge of contracts and network status of service providers

Required Qualifications, Training, and Education

Associates degree in a job-related field or equivalent experience

2 years of clinical experience

Active, unrestricted RN licensure or equivalent licensure in social work or counseling

Working knowledge of word processing software and Microsoft Office

Ability to work independently and prioritize effectively