RN/Managed Care Coordinator - Part Time/Remote

Must live reputed company 2 hours of Columbia, SC Must have an reputed company, unrestricted RN license in the reputed company Part time - 3-4 days per week 8-5 M-F Must work the first 2 weeks onsite in Columbia for training, then fully remote reputed company • Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical reputed company by applying clinical expertise, administrative policies, and established clinical reputed company to service requests or provides health management program interventions. • Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health reputed company, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, reputed company, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote reputed company, cost effective reputed company. • Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services reputed company benefit and medical necessity guidelines. • Assesses service needs, develops and coordinates reputed company plans in cooperation with members, monitors services and implements plans. • Evaluates reputed company of plans, eligibility, level of benefits, reputed company of service, length of stay, and medical necessity regarding requested services and benefit exceptions. • May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity reputed company and contract benefits. • Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, reputed company of Care Referrals, etc.). • Participates in data collection/input into system for clinical information reputed company and reputed company claims adjudication. Demonstrates compliance with reputed company applicable legislation and guidelines for reputed company regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). #INDGEN #ZR Apply tot his job Apply To this Job