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LPN Utilization Management Coordinator I at BlueCross BlueShield of South Carolina - ApplyBlast

LPN Utilization Management Coordinator I

BlueCross BlueShield of South Carolina

1 day ago

Remote

Full Time

Junior

0 applicants

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About this role

The LPN Utilization Management Coordinator I at BlueCross BlueShield of South Carolina performs medical and pharmacy reviews using established criteria to determine eligibility, benefit levels, and medical necessity. This fully remote role involves documenting decisions using clinical guidelines, supporting discharge planning, and educating members and providers on coverage determinations and utilization management processes. The position requires an active LPN/LVN or LBSW license and a bachelor's degree in a related field.

Responsibilities

Perform medical surgical and pharmacy reviews using established criteria sets
Document decisions using indicated protocol sets or clinical guidelines
Provide education to members and their families regarding coverage determinations

Skills

Qualifications

Bachelors in a job-related fieldAccredited School of Licensed Practical NursingLicensed Vocational NursingActive, unrestricted LPN/LVN licensureactive LBSW (licensed Bachelor of Social Work)