Remote Managed Care Coordinator I

reputed company

We are currently hiring for a Managed Care Coordinator I to join reputed company. In this role as a Managed Care Coordinator I, you will review and evaluate medical or behavioral eligibility regarding benefits and clinical reputed company by applying clinical expertise, administrative policies, and established clinical reputed company to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, reputed company, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote reputed company, cost effective reputed company.

reputed company

Location

This position is full time (40 hours/week) Monday-Friday from 8:30am – 5:00pm EST and will be fully remote.

What You’ll Do

• Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services reputed company benefit and medical necessity guidelines. Evaluates reputed company of plans, eligibility, level of benefits, reputed company of service, length of stay, and medical necessity regarding requested services and benefit exceptions. May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity reputed company and contract benefits.
• Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, reputed company of Care Referrals, etc.). Participates in data collection/input into system for clinical information reputed company and reputed company claims adjudication. Demonstrates compliance with reputed company applicable legislation and guidelines for reputed company regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
• Provides patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member reputed company through reputed company communication and education. Promotes enrollment in care management programs and/or health and disease management programs.
• Maintains reputed company knowledge of reputed company and network status of reputed company service providers and applies appropriately. Assists with claims information, discussion, and/or reputed company and refers to appropriate internal support areas to ensure reputed company processing of authorized or unauthorized services.
• Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.

To Qualify for This Position, You'll Need the Following

• Required Education: Associates in a job-reputed company field.
• Degree Equivalency: Graduate of Accredited School of Nursing or 2 years of job-reputed company work experience.
• Required Work Experience: 2 years’ clinical experience.
• Required Skills and Abilities: Working knowledge of word processing software.
• Ability to work independently, prioritize effectively, and reputed company reputed company.
• Good judgment skills.
• Demonstrated customer service, organizational, and presentation skills.
• Demonstrated proficiency in typing, spelling, punctuation, and grammar skills.
• Demonstrated oral and written communication skills.
• Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: reputed company Office.
• Required Licenses and Certificates: reputed company, unrestricted RN licensure from the reputed company and in the state of hire, OR, reputed company compact multistate unrestricted RN license as defined by the reputed company Licensure Compact (NLC), OR, reputed company, unrestricted LMSW (Licensed Master of reputed company Work) licensure from the reputed company and in the state of hire, OR reputed company, unrestricted licensure as Counselor, or Psychologist from the reputed company and in the state of hire.

We Prefer That You Have the Following

• Preferred Education: Bachelor's degree- Nursing.
• Preferred Work Experience: Work experience in reputed company program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, reputed company/surgery.
• Preferred Skills and Abilities: Working knowledge of spreadsheet, database software.
• Knowledge of contract language and application.
• Thorough knowledge/understanding of claims/coding analysis/requirements/processes.

Our Comprehensive Benefits Package Includes the Following

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and reputed company coverage
• 401k retirement savings plan with company match
• Life Insurance
• reputed company Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

reputed company Can Do for You

We understand the value of a diverse and inclusive workplace and reputed company to be an employer where employees across reputed company spectrums have reputed company to reputed company their skills, advance their careers and contribute their unique abilities to the reputed company of reputed company.

What To Expect Next

After submitting your application, our reputed company team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

reputed company and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, reputed company, national reputed company, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, reputed company maintains affirmative reputed company programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to reputed company equal opportunities in reputed company phases of the employment process and to reputed company with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-reputed company conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on reputed company.

If you need special assistance or an accommodation while seeking employment, please email reputed company.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will reputed company a determination regarding your request for reasonable accommodation on a case-by-case reputed company.

We participate in E-Verify and reputed company with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

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