RN/Managed Care Coordinator
2 days ago
Columbia
Job Description One of CEI's largest Healthcare clients is seeking a RN/Managed Care Coordinator to join their growing organization! Client/Industry: Healthcare/Insurance Job Title: RN/Managed Care Coordinator Location: Hybrid – Must be onsite for 1st week, then 100% Remote | Must live within 2 hours of Columbia, SC 29229 Work Schedule/Shift: Monday–Friday, 8:00 AM–4:30 PM or 8:30 AM–5:00 PM | Minimum 40 work hours per week. Duration/Length of Assignment: 4 Month Contract to Hire Pay Rate: $31.25 per hour Additional Information: Equipment provided. Panel interviews conducted via Microsoft Teams. • W2 Employment Only – No Corp to Corp / C2C arrangements., • Expected potential for contract extension(s) and/or conversion to Full-Time/Permanent Employment. Required Skills/Experience/Qualifications: • Associate Degree in Nursing, or Graduate of an Accredited School of Nursing, or Master’s degree in Social Work (for Div. 6B or Div. 75), or Master’s in Psychology or Counseling (for Div. 75 only), • Minimum of 4 years recent clinical experience in a defined specialty area such as oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, or general medicine/surgery, • Alternatively, 4 years of utilization review, case management, clinical, or a combination of these, with at least 2 years in clinical practice, • Active, unrestricted RN license in the state of hire, or a compact multistate unrestricted RN license (Nurse Licensure Compact), • For Div. 6B roles: Active, unrestricted licensure as a social worker in the state of hire, • For Div. 75 roles: Active, unrestricted licensure as a counselor or psychologist in the state of hire, • For Div. 6B and Div. 75: Ability to obtain a URAC recognized Case Management Certification within 4 years of hire, • Working knowledge of spreadsheets and database software, • Strong communication, active listening, and time management skills, • Ability to work independently, prioritize effectively, and apply critical thinking, • Bachelor’s degree in Nursing, • 7 years of healthcare program management experience, • Case Manager certification, • Clinical certification in specialty area, • Manage a caseload of members telephonically, providing care coordination, discharge planning, and triage support as needed, • Conduct intensive assessment and evaluation of member conditions to determine care needs and next steps, • Develop and coordinate care plans in collaboration with members, providers, and team members, ensuring alignment with service needs and goals, • Monitor services and implement action plans, including evaluating outcomes related to eligibility, benefits, place of service, and medical necessity, • Accurately document clinical information to support medical necessity criteria and benefit determinations, • Provide telephonic support for members with chronic conditions, high-risk pregnancies, or other at-risk health situations, • Deliver member-centered coaching using motivational interviewing techniques and reflective listening to drive behavior change and increase program engagement, • Perform medical or behavioral review and authorization processes, ensuring services meet benefit and medical necessity guidelines, • Make referrals to internal resources such as Medical Director, Preventive Services, Quality of Care, and Case Management teams as appropriate, • Participate in data entry and system updates to maintain proper flow of clinical information and claims adjudication, • Maintain compliance with applicable legislation and standards, including ERISA, NCQA, URAC, DOI (State), and DOL (Federal), • Provide education and communication to members and providers on healthcare delivery systems, utilization of networks, and benefit plans, • Advocate for members through ongoing communication, care management program promotion, and disease management program enrollment, • Maintain current knowledge of contracts, provider networks, and claim processes to support proper service delivery and resolution, • Communicate determinations and updates to healthcare providers and members through written and telephonic correspondence#INDCEICEI is a rapidly expanding leading end-to-end Solutions provider driving transformation and innovation for our customers to help harness change to gain competitive advantage through Advisory Services, Custom Software Solutions, Application Management and Staffing Solutions.\r\n\r\nFounded in 1992, CEI is a minority co-founded and owned enterprise and is certified as a Minority Business Enterprise with continued growth and success. CEI has been acknowledged on the Inc. 5000 list for the fifth time for year-over-year growth.\r\n\r\nCEI is headquartered in Pittsburgh, PA with regional offices in Cincinnati OH, Washington, DC; Philadelphia, PA; Denver CO; Orlando, FL; Charlotte NC; Chicago IL and Virginia Beach, VA. We also have a multi-national presence in Peru, Spain and India.