South Carolina Licensed RN Reviewer

Job Summary

Reviewing medical documentation remotely, the full-time South Carolina Licensed RN Reviewer will perform medical reviews of home health and hospice documentation, ensuring compliance with program requirements while supporting medical claims and utilization practices.

Key responsibilities

• Conduct medical claim reviews for complex services, making determinations on medical necessity and appropriateness based on established guidelines
• Educate internal and external staff on medical reviews and coverage determinations, ensuring adherence to contractor guidelines
• Participate in quality control activities and provide guidance to LPN team members while assisting with special projects as assigned

Required qualifications

• Associate Degree in Nursing or graduate of an accredited School of Nursing
• Two years of clinical experience
• Active RN licensure in South Carolina or an active compact multistate RN license
• Working knowledge of Microsoft Office and word processing software
• Experience in critical care or home health and hospice settings is preferred