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 and evaluate eligibility and medical necessity

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

Provide patient education and advocacy regarding healthcare delivery systems and promote enrollment in care management programs

Required Qualifications

Associates degree in a job-related field or equivalent experience

2 years of clinical experience

Active, unrestricted RN licensure or LMSW licensure from the United States

Working knowledge of Microsoft Office

Ability to work independently and prioritize effectively