South Carolina RN Medical Reviewer
Job Summary
A company is looking for an RN Medical Reviewer II to perform medical reviews and support medical claims and utilization practices.
Key Responsibilities
- Conducts medical claim reviews for complex services and preauthorization requests
- Determines medical necessity and appropriateness for coverage and reimbursement
- Educates staff on medical reviews, terminology, and coding procedures
Required Qualifications
- Associate Degree in Nursing or graduation from an accredited School of Nursing
- Valid, active, unrestricted RN licensure in the state of hire or active compact multi-state RN licensure
- Two years of clinical nursing experience
COMPLETE JOB DESCRIPTION
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