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RN / Managed Care Coordinator

Health Care | Columbia, SC | Full Time

Job Description

RN / MANAGED CARE COORDINATOR

InGenesis Solutions has an opportunity for a RN/Managed Care Coordinator to come join our client located in Columbia, SC! As the RN/Managed Care Coordinator with a large health insurance provider, you will be responsible for reviewing and evaluating medical or behavior eligibilities regarding benefits and clinical criteria. You’ll successfully complete these highly important assignments by applying clinical expertise, administrative policies and previous established clinical criteria. In this role, you’ll also utilize your clinical proficiency and claims knowledge to assess, plan, implement, coach, coordinator, monitor and evaluate medical necessity. So, if you’re ready to join an organization that serves millions of South Carolinians, apply today!

ROLES AND RESPONSIBILITIES:

  • Perform medical or behavioral review/authorization process

  • Ensure coverage for appropriate services within benefit and medical necessity guidelines

  • Assess service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans

  • Evaluate outcomes of plans, eligibility, level of benefits, place of service, length of stay and medical necessity regarding requested services and benefit

  • Ensure accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits

  • Utilize allocated resources to back up review determinations

  • Identify and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.)

  • Participate in data collection/input into system for clinical information flow and proper claims adjudication

 

REQUIRED QUALIFICATIONS:

 

  • Associate Degree in Nursing

  • 2+ years of clinical experience

 

BENEFITS OFFERED:

  • Competitive Salary

  • Paid Time Off

  • Paid Federal Holidays

  • Medical, Dental, Vision Health Insurance Plans

  • 401K Retirement Plan

  • Life and Disability Insurance

 

We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.