RN/Managed Care Coordinator - Remote

RN/Managed Care Coordinator - Remote

Job at a Glance

• Title: RN/Managed Care Coordinator
• Location: Columbia, SC (on-site training during the first week; remote thereafter. Must reside within 2 hours of Columbia, SC.)
• Contract: W2 only
• Pay: $ 30 /hour + optional medical, dental, vision, 401(k) match
• Must have an active unrestricted RN license in the state of South Carolina and 4+ years recent clinical experience.

Overview
We are seeking a Managed Care Coordinator to provide telephonic case management and clinical review support for members with chronic, acute, and at-risk conditions. This role applies clinical expertise and established criteria to assess needs, coordinate services, and promote quality, cost-effective outcomes. The ideal candidate brings recent clinical experience, strong communication skills, and the ability to deliver member-centered coaching and education.

Key Responsibilities

• Provide telephonic case management, including assessment, care planning, and ongoing monitoring of member goals and outcomes.
• Evaluate eligibility, benefits, level of care, length of stay, and medical necessity to support appropriate services and benefit exceptions.
• Document clinical information accurately to support medical necessity determinations and benefits coverage.
• Perform review and authorization activities in alignment with clinical guidelines and applicable policies.
• Coordinate referrals to appropriate internal clinical and support resources when needed.
• Educate and coach members using motivational interviewing, reflective listening, and readiness-to-change techniques to improve engagement.
• Communicate with members, providers, and interdisciplinary teams to ensure coordinated care and appropriate resource utilization.

Required Skills

• Experience providing telephonic case management and coordinating care plans for members with chronic and/or high-risk conditions.
• Strong clinical assessment skills and ability to apply clinical criteria to determine medical necessity and appropriate services.
• Excellent verbal and written communication skills for member/provider interactions and documentation.
• Demonstrated ability to work effectively within regulated healthcare environments and comply with applicable standards and guidelines.
• Adaptability to evolving case management processes and workflows.
• Recent adult care experience.
• For Registered Nurses: at least 4 years of recent clinical experience.

Education

• Associate Degree in Nursing, graduate of an accredited school of nursing, or other qualifying graduate degree path (e.g., Master’s in Social Work; Master’s in Psychology or Counseling, as applicable to the role requirements).

Preferred Skills

• Bachelor’s degree in Nursing.
• Utilization review and/or case management experience (including blended clinical and review experience).
• Case management certification and/or clinical certification in a defined specialty area.
• Healthcare program management experience.
• Reliable high-speed internet with direct (wired) connection capability; ability to maintain a dedicated, private home workspace suitable for confidential phone-based work.

Why Should I Apply?
This role offers the opportunity to support members through impactful, outcomes-focused care coordination while working in a structured environment with remote flexibility after initial training.

About CEI:
As a trusted technology partner, CEI delivers solutions that help our customers transform their business and achieve meaningful results. From strategy and custom application development through application management - our technology and digital experience services are tailored to meet each unique need of our customers. Our staffing solutions bring specialized skills to complement our customers' workforce and project requirements.

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