South Carolina Licensed Medical Reviewer
Job Summary
Working remotely in a full-time capacity, the South Carolina Licensed Medical Reviewer will perform medical reviews of claims, determine medical necessity, and document decisions based on clinical guidelines.
Key responsibilities:
- Conduct medical claim reviews for complex services and preauthorization requests
- Make payment determinations based on clinical information and established criteria
- Educate internal and external staff on medical reviews and coverage determinations
Required qualifications:
- Associate's degree in a job-related field or a graduate of an accredited School of Nursing
- Active RN licensure in South Carolina or a compact multistate RN license
- Two years of clinical experience
- Proficiency in Microsoft Office
- Ability to work independently and make sound decisions
Complete Job Description
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