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RN - Managed Care Coordinator

Health Care | Columbia, SC | Temp to Perm

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 eligibility 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. This truly is an exciting opportunity perfect for a professional who has an extensive background of clinical experience. 

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


INGENESIS OFFERS:

  • Competitive Salary

  • Paid Time Off

  • Paid Federal Holidays

  • Medical, Dental, Vision Health Insurance Plans

  • 401K Retirement Plan

  • Life and Disability Insurance


ABOUT US

Established in 1998, InGenesis enjoys a long history of positive government and commercial relationships with healthcare industry professionals and businesses nationwide. We are the recent recipients of an Inc. 5000 award and dedicated to servicing our customers.

InGenesis is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.

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