South Carolina Licensed Medical Reviewer

Job Summary

A company is looking for a Medical Reviewer I to perform medical reviews and utilization management of services and claims.

Key Responsibilities

• Conduct medical claim reviews and determine appropriate payment and coverage based on guidelines
• Educate staff and respond to inquiries regarding medical reviews and coverage determinations
• Participate in quality control activities to support corporate and team objectives

Required Qualifications

• 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 LBSW licensure in the state of hire
• Working knowledge of Microsoft Office
• Ability to handle confidential information with discretion