South Carolina Licensed Payment Integrity Nurse

Job Summary

To support quality improvement initiatives, the full-time South Carolina Licensed Payment Integrity Nurse will conduct medical reviews, analyze findings, and coordinate HEDIS data collection while working remotely after an initial training period.

Key responsibilities

• Performs quality improvement activities to ensure compliance with applicable standards and regulations
• Analyzes and documents findings from quality reviews and recommends corrective actions
• Coordinates the collection of HEDIS data and conducts medical record reviews to monitor care quality

Required qualifications

• Associate's degree in a job-related field
• Four years of clinical or behavioral health experience, including two years in quality management
• Active, unrestricted RN licensure or equivalent in the state of hire
• Proficiency in Microsoft Office
• Demonstrated ability to implement corrective actions and a strong understanding of managed care