South Carolina Licensed Medical Reviewer

Job Summary

South Carolina Licensed Medical Reviewer, performs full-time medical reviews of claims using clinical information and established guidelines, while working remotely from South Carolina.

Key Responsibilities

• Conduct medical claim reviews and determine medical necessity and appropriateness for coverage and reimbursement
• Educate staff on medical reviews, terminology, and coding procedures
• Participate in quality control activities and provide guidance to team members

Required Qualifications

• Associate's degree in a job-related field or graduate of an accredited School of Nursing
• Active RN licensure in the state hired or active compact multistate RN license
• Minimum of 2 years of clinical experience
• Working knowledge of word processing software
• Ability to work independently and prioritize effectively