Offering insurance and serving over 20 million South Carolina residents, our client is looking to bring on Licensed Practical Nurses and Certified/Registered Medical Assistants for various contract-to-hire and work-from-home opportunities.

If you possess the following, please apply today:

• Unrestricted LPN license valid in South Carolina
• Certified Medical Assistant
• At least three years of clinical experience
• Microsoft Office Suite proficiency
• Insurance industry and case management experience is a plus

Pay Rate: $18-$24.00/hour

Schedule: Monday - Friday 8:30 am - 5:00 pm

Responsibilities:

LPN Job Responsibilities

• Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices.
• May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment determination.
• Monitors process's timeliness in accordance with contractor standards. Performs authorization process, ensuring coverage for appropriate medical services within benefit and medical necessity guidelines.
• Utilizes allocated resources to back up review determination. Reviews interdepartmental requests and medical information in a timely/effective manner in order to complete utilization process.
• May conduct/perform high dollar forecasting research and formulate overall patient health summaries with future health prognosis and projected medical costs. Performs screenings/assessments and determines risk via telephone. Reviews/determines eligibility, level of benefits, and medical necessity of services and/or reasonableness and necessity of services.
• Provides education to members and their families/caregivers.
• Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each determination and basis for each. Conducts research necessary to make thorough/accurate basis for each determination made.

Certified Medical Assistant Responsibilities

• Provides health coaching or intervention telephonically or in person for assigned health programs. Utilizes all data systems containing patient information and documents information appropriately.
• Assists with the identification of areas for which there is a need for health management programs. Monitors quality indicators and develops programs to positively impact areas where improvement is warranted.
• Develops patient/provider educational materials for members/providers.
• Assists with implementation of health management activities/programs for membership.
• Facilitates program to participants and focuses emphasis on medium-risk patients. Follows/updates established procedures. May conduct research and analysis of reports (monthly, quarterly, and annually).
• Assists with the development of strategies to increase effectiveness of and participation in health management programs. Establishes/maintains effective communications with provider network, group, representatives, and members.

Expected hours: No more than 40 per week

Benefits:

• Health insurance
• On-the-job training

Experience level:

• 2 years

Shift:

• Day shift
• No nights

Weekly day range:

• Monday to Friday
• No weekends

Work setting:

• Call center
• In-person
• Office

Work Location: In person and work from home possibilities

Job Type: Contract

Pay: $18.00 - $24.00 per hour

Expected hours: 40 per week

Benefits:

• Health insurance

Schedule:

• 8 hour shift
• Monday to Friday
• No nights
• No weekends

Travel requirement:

• No travel

Experience:

• Clinical: 2 years (Required)
• Managed care: 1 year (Preferred)
• Writing skills: 1 year (Preferred)

Ability to Commute:

• Columbia, SC 29203 (Required)

Ability to Relocate:

• Columbia, SC 29203: Relocate before starting work (Preferred)

Work Location: Hybrid remote in Columbia, SC 29203