South Carolina Licensed Medical Reviewer

A company is looking for a Medical Reviewer II to perform medical reviews and support medical claims. Key Responsibilities Conducts medical claim reviews and determines medical necessity based on established criteria and clinical information Educates internal and external staff on medical reviews, terminology, and coding procedures Participates in quality control activities and provides guidance to team members Required Qualifications Associate Degree in Nursing or graduate of an accredited School of Nursing 2 years of clinical experience Active RN licensure in the state hired or active compact multistate RN license Working knowledge of Microsoft Office Ability to work independently and prioritize effectively

Apr 30, 2025 - 20:33

A company is looking for a Medical Reviewer II to perform medical reviews and support medical claims. Key Responsibilities Conducts medical claim reviews and determines medical necessity based on established criteria and clinical information Educates internal and external staff on medical reviews, terminology, and coding procedures Participates in quality control activities and provides guidance to team members Required Qualifications Associate Degree in Nursing or graduate of an accredited School of Nursing 2 years of clinical experience Active RN licensure in the state hired or active compact multistate RN license Working knowledge of Microsoft Office Ability to work independently and prioritize effectively