BlueCross BlueShield of South Carolina
Case Administrator Coordinator
BlueCross BlueShield of South Carolina, Columbia, South Carolina, United States
Case Administrator Coordinator
We are currently hiring for a Case Administrator Coordinator to join BlueCross BlueShield of South Carolina. In this role, you will be responsible for supporting and maintaining the coordination of daily operations of your assigned area. You will interface with medical management on a regular basis to handle more complex utilization review (UR) cases for the outpatient UR function.
Location & Work Hours This is a full‑time (40 hrs/week) position with an 8‑hour shift between 7:00 am – 6:00 pm. The role is fully remote, but the candidate will be required to report on‑site occasionally for trainings, meetings, or other business needs.
What You’ll Do
Maintain the outpatient authorization process, ensuring benefit coverage, reviewing and determining eligibility, and reviewing established utilization review criteria.
Interpret rules and regulations and complete authorizations by following established policies and procedures.
Review interdepartmental requests and medical information to complete the utilization process.
Document the process used and decisions in the appropriate system in an accurate and timely manner.
Establish and maintain effective business relationships with primary care physician offices and other health service providers.
To Qualify For This Position, You’ll Need the Following
Education:
Graduate of an accredited School of Licensed Practical Nursing (LPN) or Licensed Vocational Nursing (LVN).
Work Experience:
3 years in managed care within a healthcare, physician's office, or insurance company setting.
Key Skills:
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.
Licenses & Certificates:
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).
Software:
Proficiency in Microsoft Office.
Our Comprehensive Benefits Package Includes The Following
Subsidized health plans, dental and vision coverage
401(k) 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
What We Can Do For You We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers, and contribute their unique abilities to the growth of our company.
What To Expect Next After submitting your application, our recruiting team will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and its subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. As a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy‑related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
When you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800‑288‑2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case‑by‑case basis.
We participate in E‑Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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Location & Work Hours This is a full‑time (40 hrs/week) position with an 8‑hour shift between 7:00 am – 6:00 pm. The role is fully remote, but the candidate will be required to report on‑site occasionally for trainings, meetings, or other business needs.
What You’ll Do
Maintain the outpatient authorization process, ensuring benefit coverage, reviewing and determining eligibility, and reviewing established utilization review criteria.
Interpret rules and regulations and complete authorizations by following established policies and procedures.
Review interdepartmental requests and medical information to complete the utilization process.
Document the process used and decisions in the appropriate system in an accurate and timely manner.
Establish and maintain effective business relationships with primary care physician offices and other health service providers.
To Qualify For This Position, You’ll Need the Following
Education:
Graduate of an accredited School of Licensed Practical Nursing (LPN) or Licensed Vocational Nursing (LVN).
Work Experience:
3 years in managed care within a healthcare, physician's office, or insurance company setting.
Key Skills:
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.
Licenses & Certificates:
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).
Software:
Proficiency in Microsoft Office.
Our Comprehensive Benefits Package Includes The Following
Subsidized health plans, dental and vision coverage
401(k) 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
What We Can Do For You We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers, and contribute their unique abilities to the growth of our company.
What To Expect Next After submitting your application, our recruiting team will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and its subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. As a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy‑related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
When you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800‑288‑2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case‑by‑case basis.
We participate in E‑Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
#J-18808-Ljbffr