Case Administrator Coordinator

BlueCross BlueShield of South Carolina

13d•Remote

About The Position

We are currently hiring for a Case Administrator Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Administrator Coordinator, you will be responsible for supporting and maintaining the coordination of daily operations of assigned area. Interfaces with the medical management on a regular basis to work more complex UR cases for the outpatient UR function. Location This position is full-time (40 hours/week) Monday-Friday with an 8-hour shift between 7:00am – 6:00pm and will be fully remote. The candidate will be required to report on-site occasionally for trainings, meetings, or other business needs.

Requirements

Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing
3 years managed care in healthcare, physician's office, or insurance company setting.
Ability to work independently, prioritize effectively, and make sound decisions.
Good judgment skills.
Demonstrated customer service and organizational skills.
Demonstrated oral and written communication skills.
Ability to handle confidential or sensitive information with discretion.
Active, unrestricted LPN/LVN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC).
Microsoft Office.

Responsibilities

Maintains the outpatient authorization process to include ensuring benefit coverage, reviewing/determining eligibility, reviewing of established utilization review criteria, interpreting rules/regulations.
Completes authorization by following established policies/procedures.
Reviews interdepartmental requests and medical information to complete utilization process.
Documents process used and decision in the appropriate system in accurate/timely manner.
Establishes/maintains effective business relationships with primary care physician offices, other providers of health services.

Benefits

We offer our employees great benefits and rewards.
You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid 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