Manage Care Coordinator (RN) - Remote

Manage Care Coordinator - RN

Job at a Glance

• Title: Manage Care Coordinator
• Location: Columbia, SC - onsite for training, then remote
• Contract: W2 only
• Pay: $ 30 /hour optional medical, dental, vision, 401(k) match
• Must live within 2 hours of Columbia, SC
• Must have an active, unrestricted RN license in the state of South Carolina

Overview
In this role, you will review and evaluate medical or behavioral eligibility using established clinical criteria, benefit guidelines, and administrative policies. You will collaborate with members and providers to coordinate services, support care plan compliance, and promote quality, cost-effective outcomes.

Key Responsibilities

• Perform medical/behavioral review and authorization activities in alignment with benefits and medical necessity guidelines.
• Assess needs, develop and coordinate member action plans, and monitor services and outcomes.
• Document clinical information accurately to support determinations and benefit/contract application.
• Identify when to escalate or refer cases to appropriate internal clinical or support resources.
• Provide member and provider education and telephonic support, including health coaching and motivational interviewing techniques.
• Maintain working knowledge of contracts and network status; assist with claims-related questions and route issues appropriately.

Required Skills

• Clinical review and medical necessity determination experience using established criteria and guidelines.
• Strong documentation skills and ability to handle confidential or sensitive information with discretion.
• Ability to work independently, prioritize effectively, and make sound decisions using good judgment.
• Demonstrated customer service, organizational, and presentation skills.
• Strong written and verbal communication skills, including persuasion/negotiation when appropriate.
• Analytical and critical thinking skills.
• Proficiency with Microsoft Office (word processing and general office tools).
• Active, unrestricted licensure in the state of hire as one of the following: RN (including compact/multistate RN as applicable), LMSW, Counselor, or Psychologist.
• Minimum 2 years of clinical experience.

Education

• Associate Degree (Nursing)

Preferred Skills

• Bachelor’s degree in Nursing.
• Working knowledge of spreadsheet and database tools (e.g., Microsoft Excel, Access, or similar).
• Knowledge of contract language and its application.
• Thorough understanding of claims/coding analysis, requirements, and processes.
• 7 years of experience in healthcare program management, utilization review, or clinical experience in a defined specialty area (e.g., oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedics, general medicine/surgery).
• Ability to support complex member scenarios (e.g., chronic conditions, high-risk pregnancy, other at-risk populations) through assessment, education, and engagement techniques.

Why Should I Apply?
This role offers the opportunity to apply clinical expertise to meaningful member outcomes while working in a structured, criteria-driven environment supporting high-impact care decisions.

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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