Summary

We are currently hiring for a Medical Informatics Administrator to join BlueCross BlueShield of South Carolina. In this role as a Medical Informatics Administrator, you will integrate clinical and medical data with automated technologies to support healthcare operations and informatics, act as a liaison between clinical expertise, data systems, and regulatory standards to ensure compliance and improve service delivery, evaluate system performance, validate workflows, and drive process improvements that enhance provider and patient experiences while reducing compliance risk.

You will serve as a liaison between the National Alliance Utilization Management team, Cohere Health, and Medical Operations to support operational procedures. Responsibilities include, but are not limited to, submitting IT data requests, conducting validity testing, performing quality check processes, managing escalations, contributing to process improvements, and communicating updates to key stakeholders.

Description

Location

This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm EST and will be fully remote.

What You’ll Do:

• Analyzes prior authorization and code set data to ensure alignment with clinical guidelines, regulatory standards, contracts, and operational requirements.
• Partners with operations, IT, and vendors to implement and validate clinical decision rules and workflows that support strategic and regulatory objectives.
• Identifies opportunities to enhance automation, reduce provider friction, and improve service turnaround times through collaboration with internal teams and external partners.
• Monitor data quality and develop reporting tools for leadership and compliance purposes. Translates complex clinical and data insights into actionable strategies.
• Evaluates system enhancements and participates in testing and validation activities to ensure successful implementation and continuous improvement.

To Qualify for This Position, You’ll Need the Following:

• Required Education: Bachelors in a job-related field
• Required Work Experience: 7 years’ clinical experience. 3 years’ experience in medical systems coordination/project implementation (concurrent with the 7 years.)
• Required Skills and Abilities: Excellent organizational, customer service, verbal and written communication, and analytical or critical thinking skills.
• Strong problem solving, presentation and project management skills.
• Good judgment skills.
• Proficient basic business math.
• Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.
• Advanced knowledge of medical systems support and medical terminology.
• 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).

We Prefer That You Have the Following:

• Extensive knowledge of Utilization Management.
• Previous experience as a Utilization Management Nurse.
• Previous experience leading a cross-functional project.
• Previous experience interacting directly with patients and stakeholders.
• Strong communication, presentation, and organization skills.
• Strong data analysis skills and techniques.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits for the first of the month following 28 days of employment.

• 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

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here’s more information.

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