Managed Care Coordinator II - Utilization Management

About the role

We are currently hiring for a Managed Care Coordinator II - Utilization Management to join BlueCross BlueShield of South Carolina. In this role as a Managed Care Coordinator II - Utilization Management, you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Location: This position is full-time (40-hours/week) Monday-Friday from 8:00am - 4:30pm and will be hybrid in Columbia, SC .