What are the responsibilities and job description for the Coordinator, Managed Care I position at Experis?
Title : Coordinator, Managed Care I
Address : Columbia, SC 29229
Duration : 3 months
Rate range : $25 to $30
Position Overview
The Utilization Review Nurse performs medical or behavioral eligibility reviews to determine benefits and clinical criteria compliance. By leveraging clinical expertise, administrative policies, and established criteria, the nurse evaluates service requests, supports members in managing their health conditions, and ensures optimal outcomes through cost-effective interventions.
Key Responsibilities
- Medical / Behavioral Review & Authorization (50%)
Conduct medical necessity and benefit eligibility reviews for requested services.
Utilize allocated resources to support review determinations.
Provide direct intervention and education to members and providers regarding health care delivery systems and benefit plans.
Maintain knowledge of contracts and network statuses for service providers.
Foster communication between healthcare providers, members, and internal teams.
Qualifications
Active RN license.
Clear and concise documentation.
Experience in various areas of work within healthcare.
Work Environment & Schedule
Team Dynamics
The team is a close-knit group experienced in precertifying outpatient procedures for office and hospital settings. Collaboration is essential, as the role involves working closely with concurrent nurses, case management, medical directors, providers, and members.
Interview Process
Candidates will participate in Microsoft Teams interviews with the hiring manager.
What We're Not Looking For
Salary : $30
