[Remote] Case Administrator Coordinator (Remote in SC)

Note: The job is a remote job and is open to candidates in USA. BlueCross BlueShield of South Carolina is seeking a Case Administrator Coordinator responsible for supporting and maintaining the coordination of daily operations in outpatient utilization review. The role involves reporting and pulling data from multiple systems to create detailed reports summarizing member healthcare spending and high-cost claims. 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. Skills • Graduate of Accredited School of Licensed Practical Nursing OR Licensed Vocational Nursing. • Three 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. • Proficient in Excel (this is a must—you'll be working in spreadsheets daily!) • Detail-oriented with strong written communication skills • Self-motivated and excellent at time management Benefits • 401(k) retirement savings plan with company match. • Subsidized health plans and free vision coverage. • Life insurance. • Paid annual leave – the longer you work here, the more you earn. • Nine paid holidays. • On-site cafeterias and fitness centers in major locations. • Wellness programs and healthy lifestyle premium discount. • Tuition assistance. • Service recognition. • Incentive Plan. • Merit Plan. • Continuing education funds for additional certifications and certification renewal. Company Overview • For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. It was founded in 1946, and is headquartered in Columbia, South Carolina, USA, with a workforce of 10001+ employees. Its website is https://www.southcarolinablues.com. Apply tot his job Apply To this Job