South Carolina Licensed RN 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 determines payment based on established criteria
• Documents medical rationale for payment or denial and educates staff on medical reviews and coding procedures
• Participates in quality control activities and provides guidance to LPN team members

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 an active compact multistate RN license
• Working knowledge of Microsoft Office and ability to handle confidential information
• Ability to work independently and prioritize effectively