RN Medical Informatics Administrator (W@H Anywhere)

BlueCross BlueShield of South Carolina

17h•Remote

About The Position

We are currently hiring for a Medical Informatics Administrator to join BlueCross BlueShield of South Carolina. In this role as a Medical Informatics Administrator, you will integrate clinical and medical data with automated technologies to support healthcare operations and informatics, act as a liaison between clinical expertise, data systems, and regulatory standards to ensure compliance and improve service delivery, evaluate system performance, validate workflows, and drive process improvements that enhance provider and patient experiences while reducing compliance risk. You will serve as a liaison between the National Alliance Utilization Management team, Cohere Health, and Medical Operations to support operational procedures. Responsibilities include, but are not limited to, submitting IT data requests, conducting validity testing, performing quality check processes, managing escalations, contributing to process improvements, and communicating updates to key stakeholders. Location This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm EST and will be fully remote.

Requirements

Bachelors in a job-related field
7 years’ clinical experience.
3 years’ experience in medical systems coordination/project implementation (concurrent with the 7 years.)
Excellent organizational, customer service, verbal and written communication, and analytical or critical thinking skills.
Strong problem solving, presentation and project management skills.
Good judgment skills.
Proficient basic business math.
Ability to handle confidential or sensitive information with discretion.
Microsoft Office.
Advanced knowledge of medical systems support and medical terminology.
Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).

Nice To Haves

Extensive knowledge of Utilization Management.
Previous experience as a Utilization Management Nurse.
Previous experience leading a cross-functional project.
Previous experience interacting directly with patients and stakeholders.
Strong communication, presentation, and organization skills.
Strong data analysis skills and techniques.

Responsibilities

Analyzes prior authorization and code set data to ensure alignment with clinical guidelines, regulatory standards, contracts, and operational requirements.
Partners with operations, IT, and vendors to implement and validate clinical decision rules and workflows that support strategic and regulatory objectives.
Identifies opportunities to enhance automation, reduce provider friction, and improve service turnaround times through collaboration with internal teams and external partners.
Monitor data quality and develop reporting tools for leadership and compliance purposes.
Translates complex clinical and data insights into actionable strategies.
Evaluates system enhancements and participates in testing and validation activities to ensure successful implementation and continuous improvement.