South Carolina Licensed Senior Medical Reviewer

Job Summary

Leading a team in specialty programs and medical review, the full-time South Carolina Licensed Senior Medical Reviewer will provide guidance and training to staff while ensuring appropriate healthcare services are delivered in a remote environment.

Key responsibilities

• Acts as a team leader, providing direction and support to staff in medical review and utilization management
• Monitors workflow and workloads, addressing aging issues and ensuring timely completion of tasks
• Participates in quality reviews and compliance initiatives, ensuring adherence to quality plans and effective communication with stakeholders

Required qualifications

• Associate Degree in Nursing or graduation from an accredited School of Nursing
• Four years of clinical experience or a combination of clinical and medical review experience totaling four years
• Active, unrestricted RN licensure in South Carolina or a compact multistate RN license
• Strong clinical experience in home health, rehabilitation, or medical-surgical settings
• Knowledge of managed care and various healthcare delivery systems