South Carolina Licensed Medical Reviewer

Job Summary

South Carolina Licensed Medical Reviewer, performs medical reviews and documentation of medical claims in a full-time remote role while collaborating with cross-functional teams.

Key Responsibilities

• Conduct medical claim reviews and determine medical necessity based on established criteria
• Educate staff on medical reviews, terminology, and coding procedures
• Participate in quality control activities and provide guidance to team members

Required Qualifications, Training, and Education

• Associate's degree in a job-related field
• Active, unrestricted RN licensure in the state of hire or compact multistate license
• 2 years clinical experience plus 1 year in utilization/medical review or quality assurance
• Working knowledge of Microsoft Office software
• Ability to work independently and prioritize effectively