South Carolina Licensed RN Medical Review Manager

Job Summary

A company is looking for an RN Medical Review Manager (IRF RCD).

Key Responsibilities

• Oversee the accurate processing of claims deferred for medical necessity review
• Ensure compliance with nationally recognized standards and local, state, and federal regulations
• Identify and implement process improvements and provide recommendations to executive management

Required Qualifications, Training, and Education

• Active RN licensure in the state hired or an active compact multistate RN license
• Bachelor's Degree in Nursing or a related field
• Five years of clinical and utilization review experience, including two years of supervisory or team lead experience
• Proficient in Microsoft Office
• Experience with Medicare payment systems and medical review processing is preferred