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 quality healthcare services are delivered, all in a fully remote capacity.

Key responsibilities

• Function as team leader, providing direction and training to staff while maintaining knowledge of unit functions
• Assist management in monitoring workflows and addressing workload issues to meet timelines
• Participate in departmental quality reviews and ensure adherence to quality plans and processes

Required qualifications

• Associates degree in a job-related field or graduate of an accredited school of nursing
• Four years of clinical experience in Behavioral Health or a combination of clinical and utilization review experience
• Active, unrestricted RN licensure in South Carolina or relevant certification in the specialty area
• Strong clinical experience, including knowledge of managed care and healthcare delivery systems
• Proficiency in Microsoft Office software