South Carolina Licensed RN Medical Reviewer

Job Summary

A company is looking for an RN Medical Reviewer II to perform medical reviews and support medical claims and utilization practices.

Key Responsibilities

• Conducts medical claim reviews for complex services and preauthorization requests
• Determines medical necessity and appropriateness for coverage and reimbursement
• Documents medical rationale and educates staff on medical reviews and coding procedures

Required Qualifications, Training, and Education

• Associate's degree in a job-related field or graduate of an accredited School of Nursing
• 2 years of clinical experience
• Active RN licensure in the state hired or active compact multistate RN license
• Working knowledge of Microsoft Office software
• Ability to work independently and prioritize effectively