[Hiring] Behavioral Health Managed Care Coordinator I @BlueCross BlueShield of South Carolina

Role Description

We are currently hiring for a Behavioral Health Managed Care Coordinator I to join BlueCross BlueShield of South Carolina. In this role, you will:

• Review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria.
• Utilize clinical proficiency and claims knowledge to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance.
• Promote quality, cost-effective outcomes using available resources.

Our ideal candidate must have previous Medicaid experience to include, but not limited to, outpatient, inpatient, ABA, and psychotherapy.

Qualifications

• Required Education: Associates in a job-related field or Graduate of Accredited School of Nursing or 2 years of job-related work experience.
• Required Work Experience: 2 years’ clinical experience.
• Required Skills and Abilities:
  • Working knowledge of word processing software.
  • Ability to work independently, prioritize effectively, and make sound decisions.
  • Good judgment skills.
  • Demonstrated customer service, organizational, and presentation skills.
  • Proficiency in typing, spelling, punctuation, and grammar skills.
  • Oral and written communication skills.
  • Ability to persuade, negotiate, or influence others.
  • Analytical or critical thinking skills.
  • Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.
• Required Licenses and Certificates:
  • Active, unrestricted RN licensure from the United States and in the state of hire, OR
  • Active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR
  • Active, unrestricted LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR
  • Active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire.

Requirements

• Previous Medicaid experience to include, but not limited to, outpatient, inpatient, ABA, and psychotherapy.
• Working knowledge of spreadsheet and database software.
• Knowledge of contract language and application.
• Thorough knowledge/understanding of claims/coding analysis/requirements/processes.

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.