South Carolina Licensed LPN Reviewer

Job Summary

A company is looking for an LPN Medical Reviewer.

Key Responsibilities

• Perform medical reviews and utilization management of professional and facility benefits or services
• Document decisions and provide support for medical claims and utilization practices
• Educate members and staff on medical reviews, coverage determinations, and coding procedures

Required Qualifications, Training, and Education

• Bachelor's degree in Social Work or graduate of an accredited school of Licensed Practical Nursing or Licensed Vocational Nursing
• 2 years of clinical experience
• Active, unrestricted LPN/LVN licensure or active, unrestricted LBSW licensure in the state of hire
• Working knowledge of Microsoft Office
• Ability to handle confidential information with discretion