South Carolina RN Managed Care Coordinator

A company is looking for a part-time RN Managed Care Coordinator I focused on DME, Home Health, and Hospice.

Key Responsibilities

Perform medical or behavioral review / authorization processes to ensure coverage aligns with benefit and medical necessity guidelines

Utilize resources for review determinations and participate in data collection for clinical information flow and claims adjudication

Provide patient education and serve as a member advocate, promoting enrollment in care management programs

Required Qualifications

Associates degree in a job-related field

Graduate of an Accredited School of Nursing or 2 years of job-related work experience

2 years of clinical experience

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

Working knowledge of Microsoft Office software