South Carolina Licensed RN Clinician

Job Summary

To support clinical member services, the full-time South Carolina Licensed RN Clinician will conduct utilization reviews to assess the medical necessity of services, ensuring compliance with clinical guidelines and regulations while working remotely.

Key responsibilities

• Assess services for members to ensure optimum outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based clinical guidelines
• Conduct reviews for prior authorization and collaborate with multidisciplinary teams

Required qualifications

• At least 2 years of experience in hospital acute care, inpatient review, or managed care
• Active and unrestricted South Carolina RN license
• Ability to prioritize and manage multiple deadlines
• Proficiency in Microsoft Office suite and applicable software programs
• Strong organizational and critical-thinking skills