RN/Managed Care Coordinator - Remote
Job at a Glance
- Title: RN/Managed Care Coordinator
- Location: Columbia, SC (on-site training during the first week; remote thereafter. Must reside within 2 hours of Columbia, SC.)
- Contract: W2 only
- Pay: $ 30 /hour + optional medical, dental, vision, 401(k) match
- Must have an active unrestricted RN license in the state of South Carolina and 4+ years recent clinical experience.
Overview
We are seeking a Managed Care Coordinator to provide telephonic case management and clinical review support for members with chronic, acute, and at-risk conditions. This role applies clinical expertise and established criteria to assess needs, coordinate services, and promote quality, cost-effective outcomes. The ideal candidate brings recent clinical experience, strong communication skills, and the ability to deliver member-centered coaching and education.
Key Responsibilities
- Provide telephonic case management, including assessment, care planning, and ongoing monitoring of member goals and outcomes.
- Evaluate eligibility, benefits, level of care, length of stay, and medical necessity to support appropriate services and benefit exceptions.
- Document clinical information accurately to support medical necessity determinations and benefits coverage.
- Perform review and authorization activities in alignment with clinical guidelines and applicable policies.
- Coordinate referrals to appropriate internal clinical and support resources when needed.
- Educate and coach members using motivational interviewing, reflective listening, and readiness-to-change techniques to improve engagement.
- Communicate with members, providers, and interdisciplinary teams to ensure coordinated care and appropriate resource utilization.
Required Skills
- Experience providing telephonic case management and coordinating care plans for members with chronic and/or high-risk conditions.
- Strong clinical assessment skills and ability to apply clinical criteria to determine medical necessity and appropriate services.
- Excellent verbal and written communication skills for member/provider interactions and documentation.
- Demonstrated ability to work effectively within regulated healthcare environments and comply with applicable standards and guidelines.
- Adaptability to evolving case management processes and workflows.
- Recent adult care experience.
- For Registered Nurses: at least 4 years of recent clinical experience.
Education
- Associate Degree in Nursing, graduate of an accredited school of nursing, or other qualifying graduate degree path (e.g., Master’s in Social Work; Master’s in Psychology or Counseling, as applicable to the role requirements).
Preferred Skills
- Bachelor’s degree in Nursing.
- Utilization review and/or case management experience (including blended clinical and review experience).
- Case management certification and/or clinical certification in a defined specialty area.
- Healthcare program management experience.
- Reliable high-speed internet with direct (wired) connection capability; ability to maintain a dedicated, private home workspace suitable for confidential phone-based work.
Why Should I Apply?
This role offers the opportunity to support members through impactful, outcomes-focused care coordination while working in a structured environment with remote flexibility after initial training.
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.
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