RN Medical Informatics Administrator; W@H

Summary

We are currently hiring for a Medical Informatics Administrator to join Blue Cross Blue Shield 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.

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

• 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.

• 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).

• 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.

• 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

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.

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.

Blue Cross Blue Shield 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…