South Carolina Licensed Medical Reviewer

Job Summary

Leading a team in medical review and utilization management, the full-time Senior Medical Reviewer will provide guidance, training, and support to staff while ensuring the delivery of appropriate healthcare services in a fully remote position based in South Carolina.

Key responsibilities

• Functions as team leader and senior-level Medical Reviewer, providing direction and training to staff
• Monitors workflow and workloads, addressing issues and reallocating tasks as necessary
• Participates in quality reviews and compliance initiatives to maintain high standards of service delivery

Required qualifications

• Associate Degree in Nursing or graduation from an accredited School of Nursing
• Four years of clinical experience, or two years of clinical and two years of medical review/utilization review experience
• Active, unrestricted RN licensure from the United States and in the state of hire, or an active compact multistate unrestricted RN license
• Working knowledge of managed care and various healthcare delivery systems
• Strong clinical experience, including home health and rehabilitation