South Carolina Licensed Utilization Manager

Job Summary

Conducting utilization reviews, the full-time South Carolina Licensed Utilization Manager will assess patient care appropriateness, monitor treatment plans, and consult with physicians while working remotely.

Key responsibilities

• Conduct utilization reviews to evaluate the appropriateness of patient care based on their illness or condition
• Monitor patient charts and treatment plans, ensuring compliance with applicable policies and regulations
• Consult with physicians and collect necessary data for treatment approvals from insurers

Required qualifications

• Bachelor's degree in Nursing from an accredited institution
• Three years of work experience as a Registered Nurse
• One year of experience in case management and/or utilization management preferred
• Licensure as a registered nurse by the state of South Carolina or a compact state
• Familiarity with InterQual or Milliman and Robinson screening criteria is desired