South Carolina Licensed Medical Reviewer

Job Summary

A company is looking for a Medical Reviewer II to perform medical reviews and support medical claims.

Key Responsibilities

• Conducts medical claim reviews and determines medical necessity based on established criteria and clinical information
• Educates internal and external staff on medical reviews, terminology, and coding procedures
• Participates in quality control activities and provides guidance to team members

Required Qualifications

• Associate Degree in Nursing or graduate of an accredited School of Nursing
• 2 years of clinical experience
• Active RN licensure in the state hired or active compact multistate RN license
• Working knowledge of Microsoft Office
• Ability to work independently and prioritize effectively