South Carolina Licensed RN Reviewer

Job Summary

A company is looking for an RN Medical Reviewer II (RCD Medicare).

Key Responsibilities

• Perform medical claim reviews for complex services, preauthorization requests, and appeals
• Determine medical necessity and document rationale for coverage decisions
• Participate in quality control activities and provide guidance to team members

Required Qualifications, Training, and Education

• Active RN licensure in the state hired or compact multistate RN license
• Associate degree in Nursing or graduate of an accredited School of Nursing
• Two years of clinical experience as an RN
• Working knowledge of word processing software
• Experience with Microsoft Office tools