Case Administrator Coordinator

Spectraforce Technologies
United States, South Carolina, Columbia
Apr 28, 2025
Role Name: Case Administrator Coordinator Location: Columbia, SC 29229 Work Environment: Remote (After Onsite training) Schedule: Mon to Fri, 6 am - 2:30pm OR 8:30 am - 5pm Contract length: 3 months assignment with possible conversion Job Summary: Duties/About the role: 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. Day to Day: 60% 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. 20% Reviews interdepartmental requests and medical information to complete utilization process. 15% Documents process used and decision in the appropriate system in accurate/timely manner. 5% Establishes/maintains effective business relationships with primary care physician offices, other providers of health services. Team Info: My team is a mix of RNs and LPNs, that review denied claims for all service types in healthcare. Any extra/additional job info: NA Job Requirements: Required Experience: Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing. Required Training: 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). Required Work Experience: 3 years managed care in healthcare, physician's office, or insurance company setting.