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Managed Care Coordinator I (31609005)
•3 days ago
| Estimated Pay | $36 per hour |
|---|---|
| Hours | Full-time, Part-time |
| Location | Columbia, South Carolina |
Compare Pay
Estimated Pay We estimate that this job pays $36.36 per hour based on our data.
$27.99
$36.36
$45.22
About this job
Seeking anRNwithManaged Care and Utilization Managementexperience to review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria. This position is remote, but requires the candidate to reside in the state of S.C. The scheduled is M-F 8:30am-5:00pm.
- Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness.
- Utilizes available resources to promote quality, cost effective outcomes.
- Performs medical or behavioral review/authorization process.
- Ensures coverage for appropriate services within benefit and medical necessity guidelines.
- Assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans.
- Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions.
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