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South Carolina Licensed Medical Reviewer
A company is looking for a Medical Reviewer II to perform medical reviews and support medical claims and utilization practices. Key Responsibilities Perform medical claim reviews for various services and determine medical necessity based on clinical information and established guidelines Educate internal and external staff on medical reviews, terminology, and coverage determinations Participate in quality control activities and provide guidance to team members while assisting with special projects as needed Required Qualifications Graduate of an accredited school of nursing or an associate's degree in a job-related field Two years of clinical experience Active RN licensure in the state hired or an active compact multistate RN license Working knowledge of word processing software and Microsoft Office Ability to work independently and prioritize effectively
A company is looking for a Medical Reviewer II to perform medical reviews and support medical claims and utilization practices.
Key Responsibilities
Perform medical claim reviews for various services and determine medical necessity based on clinical information and established guidelines
Educate internal and external staff on medical reviews, terminology, and coverage determinations
Participate in quality control activities and provide guidance to team members while assisting with special projects as needed
Required Qualifications
Graduate of an accredited school of nursing or an associate's degree in a job-related field
Two years of clinical experience
Active RN licensure in the state hired or an active compact multistate RN license
Working knowledge of word processing software and Microsoft Office
Ability to work independently and prioritize effectively