Managed Care Coordinator UM II

Ingenesis Group • Columbia, SC

139d • Remote

About The Position

We are seeking a dedicated Managed Care Coordinator to join our team. This role involves reviewing and evaluating medical or behavioral eligibility for benefits and clinical criteria, applying clinical expertise, administrative policies, and established clinical criteria to service requests. The ideal candidate will utilize their clinical proficiency, claims knowledge, and comprehensive understanding of the healthcare continuum to support members in managing their health, chronic illness, or acute illness. Schedule: Monday-Friday, 8AM-4:30PM or 8:30AM-5PM.

Requirements

• Associate Degree in Nursing, or Graduate of Accredited School of Nursing, or Master's degree in Social Work, Psychology, or Counseling.
• 4 years of recent clinical experience in a defined specialty area (e.g., oncology, cardiology, neonatology, etc.) or 4 years of utilization review/case management/clinical experience.
• Active, unrestricted RN licensure, or active compact multistate unrestricted RN license, or active, unrestricted LMSW licensure, or active, unrestricted licensure as a Counselor or Psychologist.
• Strong communication skills, ability to work independently, prioritize effectively, and critical thinking skills.
• Proficiency in Microsoft Office, with preferred knowledge of spreadsheet and database software.

Nice To Haves

• Bachelor's degree in Nursing.
• 7 years of healthcare program management experience.
• Case Manager Certification or clinical certification in a specialty area.

Responsibilities

• Perform medical or behavioral review/authorization processes, ensuring coverage for appropriate services within benefit and medical necessity guidelines.
• Provide discharge planning and assess service needs in cooperation with providers and facilities.
• Provide appropriate communications (written, telephone) regarding requested services to both healthcare providers and members.
• Participate in direct intervention/patient education with members and providers regarding the healthcare delivery system, utilization of networks, and benefit plans.
• Maintain current knowledge of contracts and network status of all service providers.

What This Job Offers

• Job Type: Full-time
• Industry: Professional, Scientific, and Technical Services
• Education Level: Associate degree