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BlueCross BlueShield of South Carolina · 22 hours ago

Case Administrator Coordinator

South Carolina, United States

Full-time

Hybrid

Mid Level

3+ years exp

BlueCross BlueShield of South Carolina is currently hiring for a Case Administrator Coordinator. In this role, you will support and maintain the coordination of daily operations, working closely with medical management on complex utilization review cases.

Financial ServicesHealth CareHealth InsuranceInsuranceMedical

Responsibilities

Maintains the outpatient authorization process to include ensuring benefit coverage, reviewing/determining eligibility, reviewing of established utilization review criteria, interpreting rules/regulations. Completes authorization by following established policies/procedures

Reviews interdepartmental requests and medical information to complete utilization process

Documents process used and decision in the appropriate system in accurate/timely manner

Establishes/maintains effective business relationships with primary care physician offices, other providers of health services

Qualification

LPN/LVN licensureManaged care experienceMicrosoft OfficeCustomer service skillsJudgment skillsDiscretion handlingPrioritization skillsOrganizational skillsOral communication skillsWritten communication skillsIndependent work abilityDecision making

Required

Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing

3 years managed care in healthcare, physician's office, or insurance company setting

Ability to work independently, prioritize effectively, and make sound decisions

Good judgment skills

Demonstrated customer service and organizational skills

Demonstrated oral and written communication skills

Ability to handle confidential or sensitive information with discretion

Active, unrestricted LPN/LVN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC)

Microsoft Office

Benefits

Subsidized health plans, dental and vision coverage

401k retirement savings plan with company match

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers in major locations

Education Assistance

Service Recognition

National discounts to movies, theaters, zoos, theme parks and more

Company

BlueCross BlueShield of South Carolina

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For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state.

Founded in 1946

Columbia, South Carolina, USA

10001+ employees