RN/Managed Care Coordinator - Remote

Computer Enterprises Inc
Columbia, SC
Category Healthcare
Job Description
Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria, applying clinical expertise, policies, and established criteria to service requests or health management programs. Emphasizes active case management, telephonic outreach, and member education to support health outcomes and prevent readmissions.

Requirements

  • Must live in South Carolina and within 2 hours of Columbia
  • Must have an active, unrestricted RN license in the state of South Carolina
  • Must be able to work the first 4-6 weeks onsite for training, then would be fully remote
  • Must have a minimum of 4 years recent clinical nursing experience
  • Case management experience preferred
  • Transition of Care experience preferred
  • Prior experience working for a health insurance company and/or with Medicare population
  • Strong communication skills, comfortable talking on the phone
  • Knowledge of MS Office (Outlook, Teams, Excel)
  • Ability to work independently
  • Flexibility and dependability
]]>