South Carolina Licensed Medical Reviewer

Job Summary

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

Key Responsibilities

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

Required Qualifications

• Associates degree in a job-related field or graduate of an accredited school of nursing
• Two 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