Managed Care Coordinator I

1 week ago


Columbia, South Carolina, United States US Tech Solutions, Inc. Full time
Job Overview:

This position involves working Monday through Friday from 8:30 AM to 5:00 PM in a remote capacity. Candidates will participate in a virtual interview process with two members of the department, followed by a week of on-site training.

Preferred Qualifications:

  • Proficient computer and typing skills are essential, as multiple software applications will be utilized in a remote work environment.
  • Key attributes include attention to detail, effective communication abilities, strong time management, organizational skills, and a collaborative spirit while also being capable of independent work.

Daily Responsibilities:

In this role, you will log in at 8:30 AM to assess the workload and prioritize tasks for the day. Incoming requests will be managed through electronic faxes and phone communications. You will evaluate requests based on the date of service or due date to establish case priorities. The review process involves comparing requests against established policies and member contracts. If a case requires further evaluation, it will be escalated to the medical director. You will finalize approvals or denials and communicate outcomes to providers.

Strong communication skills are critical, as you will interact with both members and providers regularly. Our team fosters a collaborative environment, working together to achieve shared goals and deliver exceptional service to our members. The current team consists of 12 nursing professionals, and we emphasize team-building activities to enhance our workplace culture.

Key Responsibilities:

  • Conduct thorough reviews and assessments of medical or behavioral eligibility concerning benefits and clinical criteria, utilizing clinical expertise and administrative policies.
  • Employ clinical proficiency and claims analysis to plan, implement, and evaluate care management interventions that support members in managing their health.
  • Ensure compliance with medical necessity guidelines and assess service needs, developing coordinated action plans in collaboration with members.
  • Maintain accurate documentation to support medical necessity determinations and benefit eligibility.
  • Identify and refer cases to appropriate staff members as needed, ensuring compliance with all relevant regulations.
  • Engage in direct patient education and advocacy, promoting enrollment in care management programs.

Experience Required:

  • A minimum of 2 years of clinical experience is required.

Skills Needed:

  • Proficient in word processing software and capable of working independently while prioritizing tasks effectively.
  • Strong judgment, customer service, organizational, and presentation skills are essential.
  • Excellent oral and written communication skills, with the ability to influence and negotiate.
  • Analytical thinking skills and the ability to handle sensitive information with discretion are necessary.

Educational Background:

  • An Associate Degree in Nursing or a degree from an accredited nursing program, or a Master's degree in Social Work, Psychology, or Counseling is required.

About US Tech Solutions:
US Tech Solutions is a global staffing firm offering a diverse range of talent and workforce solutions. For more information about US Tech Solutions, please visit our website. We are an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.



  • Columbia, South Carolina, United States US Tech Solutions, Inc. Full time

    Job Overview:We are seeking a dedicated Managed Care Coordinator I to support our team in delivering exceptional healthcare services. This role is primarily remote, with an initial training period conducted onsite. The successful candidate will possess strong computer skills and the ability to manage multiple tasks efficiently.Key Responsibilities:Evaluate...


  • Columbia, South Carolina, United States BlueCross BlueShield of South Carolina Full time

    Job OverviewWhy consider a career with BlueCross BlueShield of South Carolina? For over seventy years, we have established ourselves as a cornerstone of the health insurance landscape in South Carolina. Our strong presence in the community and our A.M. Best rating of A+ (Superior) underscores our commitment to excellence. As the largest health insurance...


  • Columbia, South Carolina, United States Vaya Health Full time

    Overview of the Care Coordinator RoleThe Care Coordinator role is pivotal in delivering care coordination services to individuals eligible for 1915(i) programs as outlined by the North Carolina Department of Health and Human Services. This position entails proactive engagement, comprehensive assessment, and effective care coordination to guarantee that...


  • West Columbia, South Carolina, United States Hornet Staffing, Inc. Full time

    Key ResponsibilitiesConducts assessments and evaluations of medical or behavioral eligibility for benefits and clinical criteria by leveraging clinical expertise, administrative policies, and established guidelines to service requests or implement health management interventions. Employs clinical knowledge and claims analysis to assess, plan, implement,...


  • Columbia, South Carolina, United States Vaya Health Full time

    Overview of the Care Coordinator RoleThe Care Coordinator position is essential for delivering care coordination services to individuals qualified for 1915(i) programs as designated by the North Carolina Department of Health and Human Services. This role encompasses proactive engagement, evaluation, and management of care to guarantee that members access the...


  • Columbia, South Carolina, United States US Tech Solutions, Inc. Full time

    Job Overview:This position involves working Monday through Friday from 8:30 AM to 5:00 PM in a remote capacity. Candidates will participate in a Teams interview with two members of the department, followed by a week of onsite training.Key Qualifications:Proficiency in computer usage and typing is essential, as multiple software applications are utilized in...


  • Columbia, South Carolina, United States Prisma Health Full time

    Empower Health. Serve with Empathy. Make an Impact.Position OverviewOversees targeted patient demographics to ensure efficient and effective healthcare delivery by adhering to Case Management standards as defined by the Case Management Society of America.Involves the coordination, facilitation, monitoring, and evaluation of interventions to achieve desired...


  • Columbia, South Carolina, United States Agape Care Group Full time

    About the RoleWe are seeking a compassionate and skilled Registered Nurse to join our care team as a Nurse Care Coordinator. In this role, you will be responsible for evaluating patients and creating personalized care plans, while communicating effectively with patients, families, and the care team.Key ResponsibilitiesEvaluate patients and develop...


  • Columbia, South Carolina, United States Vaya Health Full time

    LOCATION: Remote – candidates must reside in or near Buncombe County, North Carolina. This role involves travel. GENERAL STATEMENT OF JOB: The Innovations Care Coordinator (Innovations CC) is tasked with delivering proactive interventions and orchestrating care for eligible members of Vaya Health to guarantee they receive suitable assessments and...

  • Primary Care Provider

    14 hours ago


    Columbia, South Carolina, United States UMG Urgent Care Full time

    Job OverviewUMG Urgent Care is a state-of-the-art healthcare facility seeking skilled and dedicated Nurse Practitioners to join our team. As a key member of our clinical staff, you will be responsible for providing high-quality patient care and contributing to the delivery of exceptional healthcare services.Key ResponsibilitiesDiagnosis and Treatment:...


  • Columbia, South Carolina, United States Vaya Health Full time

    LOCATION: Remote – candidates must reside in or near Alamance County, North Carolina. This role involves travel. GENERAL OVERVIEW OF THE POSITION The Care Management Support Specialist, referred to as Support Specialists, will assist care managers in implementing Tailored Care Management and meeting member contact obligations. Support Specialists will...


  • Columbia, South Carolina, United States Prisma Health Full time

    Transforming Healthcare TogetherJob SummaryWe are seeking a highly skilled Care Management Support Specialist to join our team at Prisma Health. As a key member of our Care Coordination Department, you will play a vital role in supporting the day-to-day operations and reporting requirements of our team.Key ResponsibilitiesProvide administrative and technical...


  • Columbia, South Carolina, United States Vaya Health Full time

    LOCATION: Remote – must reside in or near Alamance County, North Carolina. This role is designated for individuals living in North Carolina or within 40 miles of the state border. GENERAL OVERVIEW: The Integrated Care Coordinator plays a vital role in delivering proactive support and care coordination for eligible members of Vaya Health. This position is...


  • Columbia, South Carolina, United States FAMILYTIES OF SC LLC Full time

    Position OverviewThe role of the Case Manager is essential in ensuring the effective coordination of Community Long Term Services (CLTC) for designated participants, adhering to the guidelines set forth by SCDHHS/CLTC area offices. This position involves delivering CLTC case management services through both in-person and telephonic interactions during...


  • Columbia, South Carolina, United States FAMILYTIES OF SC LLC Full time

    Position OverviewThe role of the Case Manager is essential in ensuring the effective coordination of Community Long Term Services (CLTC) for designated participants, adhering to the guidelines set forth by SCDHHS/CLTC area offices. This position involves delivering comprehensive case management services to CLTC participants through both in-person and...


  • Columbia, South Carolina, United States FAMILYTIES OF SC LLC Full time

    Job OverviewAs a Case Manager at FAMILYTIES OF SC LLC, you will play a vital role in coordinating Community Long Term Services (CLTC) for assigned participants. Your responsibilities will include delivering comprehensive case management services through both in-person and telephonic interactions during initial assessments, monthly check-ins, quarterly...


  • Columbia, South Carolina, United States University of Missouri Full time

    Position Title: Nurse Navigator Location: Columbia, Missouri Schedule: Full-time Shift: Day Job Salary Range: $75,725 - $109,554/year, commensurate with experience Overview: The University of Missouri is seeking a dedicated Nurse Navigator to enhance the general surgery oncology team at the Ellis Fischel Cancer Center. This role is essential in fostering a...


  • Columbia, South Carolina, United States Lexington Medical Center Full time

    Job Overview The Clinical Coordinator acts as a key administrative link and resource within the practice, ensuring the smooth facilitation, coordination, and management of patient care processes. This position oversees clinical personnel, manages staff assignments, maintains the vacation schedule, and supports the orientation of new team members, alongside...


  • Columbia, South Carolina, United States Lexington Medical Center Full time

    Job Overview The Clinical Coordinator acts as a key administrative liaison and resource within the healthcare practice, facilitating, coordinating, and supervising the patient care process. This position is accountable for managing clinical personnel, overseeing staff assignments, maintaining the vacation schedule, orienting new employees, and providing...


  • Columbia, South Carolina, United States Johns Hopkins Medicine Full time

    Job Summary:The Case Manager is a key member of the patient care team, responsible for implementing and coordinating patient care plans to ensure safe, timely, and efficient care. This role requires strong communication and problem-solving skills, with a focus on continuous improvement and cost-effectiveness.Key Responsibilities:Develop and implement patient...