Contingent Worker Opportunities

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Provides technical support and guidance to users. Provides troubleshooting, technical support and development of end-user guidelines. Ensures proper backing up of data from user workstations and that tools and equipment are licensed and approved by IS purchasing. Ensures proper configuration and adherence to security configurations and settings. Assists other departments as needed to resolve issues. Able to provide consultation to IT users for all aspects of end-user computing and desktop-based LAN systems software. Able to provide on-the-spot training to users. Understands operating systems imaging concepts. Able to make recommendations on selection of hardware and software products to address business requirements. Familiarity with computer and workstation equipment. Able to assist in the support and maintenance of the overall infrastructure. Associate degree in computer science, Information Technology, or other job-related field or 2 years of job-related work experience. 2 years of technical operations support experience. A+ Certification", "stars": 0.0, "medallionProgram": null, "location_flexibility": null, "work_location_option": null, "canonicalPositionUrl": "https://magnitdirectsourcing-bcb.magnitglobal.com/careers/job/446693879410", "isPrivate": false}, {"id": 446695984972, "name": "Change Management Specialist ", "location": "Columbia, South Carolina, US ", "locations": ["Columbia, South Carolina, US ", "Hybrid"], "hot": 0, "department": "Information Systems", "business_unit": "Blue Cross Blue Shield South Carolina", "t_update": 1701274162, "t_create": 1701272412, "ats_job_id": "28298538", "display_job_id": "28298538", "type": "ATS", "id_locale": "28298538-en", "job_description": "Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we\u2019ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we\u2019re stronger than ever. Our A.M. Best rating is A+ (Superior) \u2014 making us the only health insurance company in South Carolina with that rating. We\u2019re the largest insurance company in South Carolina \u2026 and much more. We are one of the nation\u2019s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Notes:\u00a0 ServiceNow experience is a big plus.  This is a Hybrid opportunity needing to come into the Columbia SC office 2 days a week.  Estimated contract duration is 12 months.  Change management experience is required.  We are focusing on candidates that have a history of analytical skills related to reporting and trend analysis, leading projects and process improvements, and communicating with various levels of management.  Job Summary:  Responsible for tactical management activities of technical workflow throughout the department (i.e. infrastructure deployments, decommissions, audits, maintenance, break/fix, etc.) at a cross functional level. Coordinates technical teams to ensure an efficient, logical flow of all inter-related work. Provides key department-wide reporting statistics, and explanation to management regarding historical tactical trends along with data-based recommendations for tactical adjustments required to keep the workflow efficient at the team level.  Job Responsibilities:  60% Coordinates technical teams for work coming into the area.  Monitors teamwork assignments.  Ensures the tactical assessment and completion all cross functional work is as efficient, timely and cost effective as possible for assigned teams and work types. 15% Identifies the activities required to define business goals by meeting with Team Leads and Staff of technical teams to obtain details and understanding of processes/objectives.  Assists with the development of flowcharts/outlines for process improvement and definitions of assigned work types.  10% Performs ongoing tracking of assigned work types and teams and facilitates communication to ensure work tasks and major milestones are achieved.  Identifies and analyzes gaps between flowchart/outline items and the desired state. Makes recommendations to improve productivity, cost effectiveness, and timeliness. 5% Prepares complex and customized reports for management or staff as it relates to the flow and status of assigned work types through the department with a focus on work involving multiple teams.  Identifies the impacts of adjustments that effect the master schedule, budget, productivity etc., of the work efforts, and communicates with area senior personnel and management on these items.  5% Maintains effective relationships with business partners by leading and participating in meetings.  5% Participates in process improvement initiatives, training, and policy and procedure development.  Minimum Required Skills and Abilities:  Strong experience with of project management tools, principles, and methodologies. Proven ability to identify resource needs, perform quality review, and escalate tactical workflow issues appropriately.  Proven use of change management techniques.  Proven ability to direct the workflow of more than one technical team with over 50 day-to-day technical deliverables.  Proven ability to coordinate workflow delivery and prioritization with multiple groups. Excellent interpersonal and communication skills (written, oral, and listening).  The incumbent must have a proven record of successful project or major deliverable completion involving more than one team at a time.  Able to communicate information to both technical and non-technical people. Strong negotiation/persuasion skills.  Strong organizational and analytical skills.  This position must be able to manage multiple work efforts simultaneously among multiple teams to keep the flow of work moving as fast, effective and cost efficient as possible.  Minimum Required Software and Tools:  Advance knowledge of Microsoft Office and reporting software tools.  Required Education:  Bachelor's degree in computer science, Business Management or other job-related degree  or  4 years of job-related work experience  or  2 years of job-related experience plus an associate degree in computer science, Business Administration or other job-related degree.  Required Work Experience: 5 years of job-related experience in a similarly complex technical organization. Pay Transparency: The pay range that Magnit reasonably expects to pay for this position: $39.54-$39.64/hour. Benefits: Medical, Dental, Vision, 401K (provided minimum eligibility hours are met). BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We\u2019ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.\u00a0 Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson.\u00a0If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.\u00a0If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!\u00a0", "stars": 0.0, "medallionProgram": null, "location_flexibility": null, "work_location_option": null, "canonicalPositionUrl": "https://magnitdirectsourcing-bcb.magnitglobal.com/careers/job/446695984972", "isPrivate": false}, {"id": 446695983927, "name": "Assistant, Project", "location": "Greenville, South Carolina, US ", "locations": ["Greenville, South Carolina, US "], "hot": 0, "department": "Clerical/Administrative", "business_unit": "Blue Cross Blue Shield South Carolina", "t_update": 1701268361, "t_create": 1701116286, "ats_job_id": "28211382", "display_job_id": "28211382", "type": "ATS", "id_locale": "28211382-en", "job_description": "Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we\u2019ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we\u2019re stronger than ever. Our A.M. Best rating is A+ (Superior) \u2014 making us the only health insurance company in South Carolina with that rating. We\u2019re the largest insurance company in South Carolina \u2026 and much more. We are one of the nation\u2019s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Notes: Pay 17.50/hr Monday-Friday 8:30am-5:00pm Contract to perm-based on performance Manager will conduct phone interviews Onsite training about 30 days Remote 3 days a week/onsite 2 days a week Will have own office Team of 15 individuals, admin works for 1 sales rep, 2 account reps 2 service reps, team services over 300 groups Responsibilities: Reporting from database, take some calls, send out contracts to clients, emailing contracts Provides a wide variety of administrative and staff support services. Coordinates more complex and diverse area specific projects. Administers programs, projects and processes requiring area specific knowledge. Operates a desktop computer and is proficient in working with assorted software, tools and systems utilized in the area. Provides coordination for a variety of area specific projects. Completes project support functions. Gathers information. Prepares letters, reports, graphs, forms or presentations. Organizes and expedites the flow of work through management's office, including maintenance of highly confidential files and records, both paper and electronic. Coordinates with purchasing to ensure adequate supplies are on hand at all times. Coordinates and completes special projects as assigned by management. Required Skills and Abilities:  Strong organizational skills. Good judgment skills. Excellent written and verbal communication skills. Basic business math proficiency. Strong analytical or critical thinking skills. Excellent knowledge of business etiquette and letter composition. Excel Preferred Skills and Abilities: Customer service skills. Ability to persuade, negotiate, and/or influence. Preferred Software and Tools:  Knowledge of Harvard graphics or PowerPoint. Knowledge of Microsoft Office software. Ability to run DB2 queries. Required Education:  Associate's Degree or two years of job related work experience or a combination of education and experience equal to 2 years. Required Work Experience:  2 years of project coordination or other job related work experience including 1 year working proficiently with word processing, desktop publishing, spreadsheet and database applications software. Preferred Work Experience: 3 years of administrative, project specialization, or industry-specific experience including computer/software such as Word/Excel/Harvard graphics and desktop publishing or similar. Hourly Pay Rate Range (dependent on location, experience, expectation) The pay range that Magnit reasonably expects to pay for this position is: $17.00/hour- $17.50 /hour Benefits: Medical, Dental, Vision, 401K\u00a0 BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We\u2019ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.\u00a0 Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson.\u00a0If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.\u00a0If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!", "stars": 0.0, "medallionProgram": null, "location_flexibility": null, "work_location_option": null, "canonicalPositionUrl": "https://magnitdirectsourcing-bcb.magnitglobal.com/careers/job/446695983927", "isPrivate": false}, {"id": 446695968978, "name": "Customer Service Advocate I", "location": "Columbia, South Carolina, US ", "locations": ["Columbia, South Carolina, US "], "hot": 0, "department": "Clerical/Administrative", "business_unit": "Blue Cross Blue Shield South Carolina", "t_update": 1701273644, "t_create": 1701101233, "ats_job_id": "28210568", "display_job_id": "28210568", "type": "ATS", "id_locale": "28210568-en", "job_description": "Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we\u2019ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we\u2019re stronger than ever. Our A.M. Best rating is A+ (Superior) \u2014 making us the only health insurance company in South Carolina with that rating. We\u2019re the largest insurance company in South Carolina \u2026 and much more. We are one of the nation\u2019s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Notes: The assigned shift will be 8 hours between the hours of 8am and 8pm. Onsite 4-5 months with the opportunity of extension Responsibilities: Provides prompt, accurate, thorough and courteous responses to all customer inquiries.  Performs research as needed to resolve inquiries. Ensures effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk-in inquiries.  Accurately documents inquiries.  Initiates or processes adjustments or performs other research as needed to resolve inquiries.  Coordinates with other departments to resolve problems.  Responds to, researches and/or assists with priority inquiries and special projects as required by management.  Provides feedback to management regarding customer problems, questions and needs.  Maintains accurate records on complaints and/or other customer comments, and makes recommendations for changes to management.  Follows through on complaints until resolved or reports to management as needed. Maintains basic knowledge of quality work instructions and company policies.  Assists with process improvements through the recommendation of changes in procedures and techniques discovered during daily operations.  Maintains all departmental productivity, quality, and timeliness standards.  Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.  Required Skills and Abilities:  Excellent verbal and written communication skills.  Strong human relations and organizational skills.  Ability to handle high stress situations.  Good judgment skills.  Strong customer service skills.  Ability to learn and operate multiple computer systems effectively and efficiently.  Required Education: High School Diploma or equivalent  Preferred Education:  Associate Degree  Preferred Work Experience:  2 years-of customer service or call center experience. Hourly Pay Rate Range (dependent on location, experience, expectation) The pay range that Magnit reasonably expects to pay for this position is: $15.00/hour-$15.50/hour Benefits: Medical, Dental, Vision, 401K\u00a0 BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We\u2019ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.\u00a0 Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson.\u00a0If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.\u00a0If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!", "stars": 0.0, "medallionProgram": null, "location_flexibility": null, "work_location_option": null, "canonicalPositionUrl": "https://magnitdirectsourcing-bcb.magnitglobal.com/careers/job/446695968978", "isPrivate": false}, {"id": 446695984706, "name": "Quality Navigator (RN)", "location": "Columbia, South Carolina, US ", "locations": ["Columbia, South Carolina, US ", "Remote"], "hot": 0, "department": "Medical/Healthcare", "business_unit": "Blue Cross Blue Shield South Carolina", "t_update": 1701290677, "t_create": 1700591767, "ats_job_id": "27806772", "display_job_id": "27806772", "type": "ATS", "id_locale": "27806772-en", "job_description": "Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we\u2019ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we\u2019re stronger than ever. Our A.M. Best rating is A+ (Superior) \u2014 making us the only health insurance company in South Carolina with that rating. We\u2019re the largest insurance company in South Carolina \u2026 and much more. We are one of the nation\u2019s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Notes:  Max Pay rate $35-$40. (based on experience) Hours/Schedule: 8:00am-5:00pm Monday-Friday. Training will be remote with the possibility to come into the office at Percival Road if necessary for business workflow. QN will be responsible for travel to provider offices within the Columbia and Pee Dee Region of the state to pull or obtain medical records onsite if requested. Need to reside in SC, NC, or GA and have the ability to travel to provider offices within the state of SC. Contractor will be provided with a laptop, monitors, router/converter for dual screens, mouse, keyboard, headset, and any additional items required to complete their job. Responsibilities: Abstracts and reviews medical records for HEDIS (Health Plan Employer Data Information Set) for both prospective and retrospective seasons to ensure that our Company complies with NCQA (National Committee for Quality Assurance) standards and achieves its CMS (Centers for Medicare &amp; Medicaid Services) Star rating. Performs quality improvement activities to monitor/maintain quality of care and compliance with applicable standards/regulations. Educates network providers on HEDIS clinical measures and coding accuracy . Responsible for continuing education on HEDIS/NCQA measures. Performs/coordinates HEDIS data collection, and NCQA accreditation activities. Abstracts and reviews medical records for HEDIS for both prospective and retrospective seasons to ensure that our Company complies with NCQA standards and achieves its CMS Star rating. Researches and stays up to date on all HEDIS clinical measures and NCQA standards/guidelines. Performs quality improvement activities to monitor/maintain quality of care and compliance with applicable standards/regulations. Tracks/trends/investigates quality concerns and complaints. Educates network providers on HEDIS clinical measures and coding accuracy. Keeps providers up to date on HEDIS clinical measures. Works with providers to collect medical records and provides support to close gaps in care. Recommends corrective action or improvement to providers when necessary. Develops training materials for provider education. 1 Participates in other assigned projects. Performs/coordinates HEDIS data collection and NCQA accreditation activities. Responsible for continuing education on HEDIS/NCQA measures. Provides HEDIS training for new employees. Requirement: Previous HEDIS Experience, Experience with Microsoft Suite (Excel/Word/Outlook), Previous Experience with Insurance/Healthcare Quality, A  minimum of 2 years of direct patient care, non-RN's Flexible/Adaptable with frequently changing priorities, strong communication skills (will be working with providers to obtain/follow up on medical record request and provide education to providers on any NCQA updates/changes with HEDIS measures. Excellent verbal and written communication, customer service, organizational, presentation, problem solving, and analytical or critical thinking skills. Proficient spelling, grammar, punctuation, and basic business math. Ability to handle confidential or sensitive information with discretion. Demonstrated ability to identify the need for and implement corrective actions. Strong understanding of managed care. The team currently has 5 quality navigators assigned across the state of SC. We have a strong focus on teamwork and collaboration across the various navigator teams. The management team provides a list each week of current priorities, and each Quality Navigator is able to work independently to prioritize their duties and focus each day to align with the weekly priority guidance given. Software and Other Tools:  Microsoft Office, various provider EMRs, and database software. Work Environment:  Travel is required approximately 80% of the time with occasional out of town travel. May work from home if eligibility criteria are met. Minimum Education Requirements: Associate Degree- Nursing Minimum Work Experience: 4 years-clinical experience to include 2 years of experience in a clinical area providing patient care. 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). Preferred Education: Bachelor\u2019s degree - Nursing Preferred Work Experience: Previous HEDIS and/or provider education experience. Coding knowledge and/or experience. Hourly Pay Rate Range (dependent on location, experience, expectation) The pay range that Magnit reasonably expects to pay for this position is: $35.00/hour-$40.00/hour Benefits: Medical, Dental, Vision, 401K\u00a0 BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We\u2019ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.\u00a0 Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson.\u00a0If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.\u00a0If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!", "stars": 0.0, "medallionProgram": null, "location_flexibility": null, "work_location_option": null, "canonicalPositionUrl": "https://magnitdirectsourcing-bcb.magnitglobal.com/careers/job/446695984706", "isPrivate": false}, {"id": 446695653697, "name": "Reviewer III, Medical", "location": "Columbia, South Carolina, US ", "locations": ["Columbia, South Carolina, US "], "hot": 0, "department": "Medical/Healthcare", "business_unit": "Blue Cross Blue Shield South Carolina", "t_update": 1700980936, "t_create": 1699558579, "ats_job_id": "27511944", "display_job_id": "27511944", "type": "ATS", "id_locale": "27511944-en", "job_description": "Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations. Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines. Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement. Documents medical rationale to justify payment or denial of services and/or supplies. Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Participates in quality control activities in support of the corporate and team-based objectives. Provides guidance, direction, and input as needed to LPN team members. Provides education to non-medical staff through discussions, team meetings, classroom participation and feedback. Assists with special projects and specialty duties/responsibilities as assigned by Management. Working knowledge of managed care and various forms of health care delivery systems; strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience. Knowledge of specific criteria/protocol sets and the use of the same. Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated 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. Associate Degree Nursing, OR, 4-year degree in health-related field, OR, Master's Degree in Occupational Therapy or Physical Therapy, OR, Master's Degree in Social Work, Psychology, or Counseling (for Div. 75 only) or Graduate of accredited School of Nursing. 2 years clinical plus 1 year utilization/medical review, quality assurance, or home health, OR 3 years clinical. FOR PALMETTO GBA (CO. 033) ONLY: 2 years clinical experience plus 2 years utilization/medical review, quality assurance, or home health experience. 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, current active, unrestricted licensure/certification from the United States and in the state of hire in specialty area as required by hiring division/area. Hourly Pay Rate Range (dependent on location, experience, expectation) The pay range that Magnit reasonably expects to pay for this position is: $30.00/hour-$30.00/hour Benefits: Medical, Dental, Vision, 401K", "stars": 0.0, "medallionProgram": null, "location_flexibility": null, "work_location_option": null, "canonicalPositionUrl": "https://magnitdirectsourcing-bcb.magnitglobal.com/careers/job/446695653697", "isPrivate": false}, {"id": 446695542246, "name": "Coordinator, Managed Care I", "location": "Columbia, South Carolina, US ", "locations": ["Columbia, South Carolina, US "], "hot": 0, "department": "Medical/Healthcare", "business_unit": "Blue Cross Blue Shield South Carolina", "t_update": 1700894076, "t_create": 1699019226, "ats_job_id": "27696477", "display_job_id": "27696477", "type": "ATS", "id_locale": "27696477-en", "job_description": "Experience: Hospital experience, UM experience 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. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated 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. Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge/understanding of claims/coding analysis/requirements/processes. Working knowledge of Microsoft Excel, Access or other spreadsheet/database software. Associate Degree - Nursing or Graduate of Accredited School of Nursing or Master's degree in Social Work, Psychology, or Counseling. 2 years clinical experience. Required License and Certificate: 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. Bachelor's degree- Nursing. 7 years-healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Reviews and evaluates 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 and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, 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. Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions that consist of: intensive assessment/evaluation of condition, at risk education based on members' identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.", "stars": 0.0, "medallionProgram": null, "location_flexibility": null, "work_location_option": null, "canonicalPositionUrl": "https://magnitdirectsourcing-bcb.magnitglobal.com/careers/job/446695542246", "isPrivate": false}, {"id": 446695634914, "name": "Reviewer I, Medical", "location": "Columbia, South Carolina, US ", "locations": ["Columbia, South Carolina, US "], "hot": 0, "department": "Medical/Healthcare", "business_unit": "Blue Cross Blue Shield South Carolina", "t_update": 1701361848, "t_create": 1698777088, "ats_job_id": "27396111", "display_job_id": "27396111", "type": "ATS", "id_locale": "27396111-en", "job_description": "A typical day would be managing a case load of members telephonically, coordinating care including discharge planning. Assisting with triage when needed. Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment determination. Monitors process's timeliness in accordance with contractor standards. Performs authorization process, ensuring coverage for appropriate medical services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determination. Reviews interdepartmental requests and medical information in a timely/effective manner in order to complete utilization process. May conduct/perform high dollar forecasting research and formulate overall patient health summaries with future health prognosis and projected medical costs. Performs screenings/assessments and determines risk via telephone. Reviews/determines eligibility, level of benefits, and medical necessity of services and/or reasonableness and necessity of services. Provides education to members and their families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each determination and basis for each. Conducts research necessary to make thorough/accurate basis for each determination made. Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Responds accurately and timely with appropriate documentation to members and providers on all rendered determinations. Participates in quality control activities in support of the corporate and team-based objectives. Participates in all required training. Working knowledge of spreadsheet, database software. Ability to work independently, prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. Working knowledge of word processing software. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Ability to remain in a stationary position and operate a computer. Working knowledge of spreadsheet and database software. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Knowledge of Microsoft Excel, Access, or other spreadsheet/database software. Bachelor's degree - Social Work, OR, Graduate of an Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing. 2 years clinical experience. Associate Degree- Nursing OR Graduate of an Accredited School of Nursing. 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). Active, unrestricted LPN/LVN licensure from the United States and in the state of hired, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LBSW (Licensed Bachelor of Social Work) licensure from the United States and in the state of hire.", "stars": 0.0, "medallionProgram": null, "location_flexibility": null, "work_location_option": null, "canonicalPositionUrl": "https://magnitdirectsourcing-bcb.magnitglobal.com/careers/job/446695634914", "isPrivate": false}, {"id": 446695404978, "name": "Specialist, Appeals", "location": "Columbia, South Carolina, US ", "locations": ["Columbia, South Carolina, US "], "hot": 0, "department": "Clerical/Administrative", "business_unit": "Blue Cross Blue Shield South Carolina", "t_update": 1699338694, "t_create": 1698159009, "ats_job_id": "26995910", "display_job_id": "26995910", "type": "ATS", "id_locale": "26995910-en", "job_description": "Performs non-medical reviews and processes redetermination letters. Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy. Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools. Updates letters and documents within the department when necessary. May gather and prepare documentation for legal inquiries and administrative requests. Demonstrated proficiency in word processing and spreadsheet software. Excellent organizational, customer service, and written and verbal communication skills. Good judgment skills. Proficiency in spelling, punctuation, and grammar skills. Computer and Data Processing experience Data Entry High School Diploma or equivalent Required Work Experience: 2 years job related field.", "stars": 0.0, "medallionProgram": null, "location_flexibility": null, "work_location_option": null, "canonicalPositionUrl": "https://magnitdirectsourcing-bcb.magnitglobal.com/careers/job/446695404978", "isPrivate": false}, {"id": 446695266466, "name": "Lead ITAM Specialist", "location": "Columbia, South Carolina, US ", "locations": ["Columbia, South Carolina, US "], "hot": 0, "department": "Information Systems", "business_unit": "Blue Cross Blue Shield South Carolina", "t_update": 1699165899, "t_create": 1697055615, "ats_job_id": "26336445", "display_job_id": "26336445", "type": "ATS", "id_locale": "26336445-en", "job_description": "Supports the asset management life cycle of information technology hardware and/or software assets throughout the organization. Accountable for the management of an IT asset portfolio. Institutionalize best practices driving standards and efficiencies specific to IT Asset Management (ITAM) functions. Represent ITAM objectives during strategic IS functions to include planning, acquisition, operations and disposal. Responsible for identifying and driving cost savings within the ITAM lifecycle, including asset harvesting for reuse, identification of opportunities during vendor renewals and contract negotiations, software and hardware license model reviews. 30% Develop and implement policies, processes and procedures in support of ITAM objectives. Identify and integrate ITAM processes with related processes within IS, to include Cloud Orchestration System (ICOS), procurement and contract management, change management, and incident management activities. 30% Lead ITAM team efforts during software vendor audits. Coordinate vendor requirements within the IS organization. Negotiate final vendor settlement. 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Strong analytical, assessment and problem-solving skills. Excellent communication, organizational, planning and time management skills, with ability to prioritize and multi-task assignments. Microsoft Office. 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