South Carolina Licensed Clinical Reviewer

Job Summary

To support a growing team, the part-time PRN South Carolina Licensed Clinical Reviewer will review medical records for compliance with criteria and regulatory standards while working remotely within the United States.

Key responsibilities:

• Review and interpret patient records to determine medical necessity and appropriateness of care
• Initiate referrals to physician consultants and process their decisions, ensuring detailed documentation of denials
• Ensure timely submission of administrative and review-related documents while maintaining confidentiality and compliance with HIPAA

Required qualifications:

• Active, unrestricted Registered Nurse (RN) License in South Carolina or an RN compact state license
• Associate's or Bachelor's degree (or Diploma) in Nursing
• 2+ years of clinical experience in an acute or med-surgical environment
• 1+ years of experience in Utilization Review (UR), Utilization Management (UM), or Prior Authorization
• 1+ years of knowledge of InterQual criteria and remote work experience