Nurse Care Coordinator

Title: Nurse Care Coordinator

Columbia, SC

90% Remote

Right to Hire

Job Description: 

• Monday-Friday, 8 hours per day with a start time of either 6am or 8:30am
• Remote position after onsite training will provide equipment.
  Interviews will be conducted either by MS teams or in person depending on candidates’ location must hold a current LPN unrestricted license
• NICE TO HAVE skill sets/qualities: Any background with filing or reviewing appeals, post-service experience highly preferred. Background with billing and coding or claims review. Broad clinical background
• A typical day would like in this role: This is a production role reviewing provider reconsideration cases, approving at the nurse level when possible and sending cases to a medical director as needed.
• Strong computing skills are a must. Keyboarding, Managing multiple applications across multiple screens, etc. Research skills.
• My team is a mix of RNs and LPNs, that review denied claims for all service types in healthcare.  

Responsibilities:

• Responsible for supporting and maintaining the coordination of daily operations of assigned area. Interfaces with the medical management on a regular basis to work more complex UR cases for the outpatient UR function.
• 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.

Experience:

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

Skills:

• Demonstrates knowledge of the outpatient authorization process, Manages business relationships

Education:

• Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing.
• 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).

About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

US Tech Solutions is an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity,
national origin, disability, or status as a protected veteran.