South Carolina Licensed RN Medical Reviewer

Job Summary

Working remotely in a full-time capacity, the South Carolina Licensed RN Medical Reviewer will perform medical reviews of claims, determine medical necessity, and educate staff on medical terminology and coverage determinations.

Key responsibilities

• Conduct medical claim reviews for complex services, ensuring compliance with established criteria and guidelines
• Educate internal and external staff on medical reviews, coding procedures, and coverage determinations
• Participate in quality control activities and provide guidance to LPN team members

Required qualifications

• Associate's degree in a job-related field or equivalent from an accredited nursing school
• Active RN licensure in South Carolina or a compact multistate RN license
• Minimum of 2 years of clinical experience
• Proficiency in Microsoft Office and word processing software
• Ability to work independently and make sound decisions