Title: Registered Nurse – Managed Care Coordinator
Location: Remote/Hybrid (South Carolina residents only), with 4 weeks onsite training
Employment Type: Contract-to-Hire
Schedule: Monday–Friday, 8:00 AM – 4:30 PM
Position Overview
We are seeking a Registered Nurse to join a clinical review team supporting a health insurance organization (Client). In this role, you will review and evaluate complex member cases, including appeals and reconsiderations. Each case is a puzzle that requires analytical thinking to put the pieces together, not a simple checklist. This is an excellent opportunity for a clinician with a critical care background who is ready to move into a payer-side role.
Required Qualifications
- Active, valid South Carolina RN license
- Must reside in South Carolina
- Clinical experience in at least one of the following areas:
- Critical care
- ICU
- Emergency Room (ER)
- Cardiac PACU
- Progressive care unit
- Step-down unit
Applicants without one of these clinical backgrounds will not be considered.Preferred Qualifications
- Appeals and reconsideration experience
- Utilization management experience
- Prior experience working for a health insurance company and/or with the Medicare population
Skills & Attributes
- Strong analytical skills: ability to assemble and evaluate complex case information
- Flexibility and dependability: team members are often called on to assist other departments
- Independence: able to work without constant direction
- Self-driven: motivated to meet productivity goals on your own
- Technical proficiency: knowledge of MS Office (Outlook, Teams, Excel) and the ability to learn and work in multiple systems at the same time
Work Arrangement
Training/Onboarding- Training is conducted onsite; expect to be in the office for a minimum of 4 weeks for orientation
Remote/Hybrid Status- Transition to remote or hybrid work depends on your pace and validation of competency
Schedule
- Regular hours: Monday–Friday, 8:00 AM – 4:30 PM
- On-call: Weekends and holidays are on-call hours (coverage is 7 days a week)
- Rotation is approximately every 4–6 weeks, once fully trained
- On-call will not begin for at least 3 months
- Call is typically less than 6 hours per assigned weekend; exceptions may occur and will be reviewed with management
Interview Process
- Virtual interview via Microsoft Teams with the Program Manager