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South Carolina Licensed RN Reviewer
A company is looking for an RN Medical Reviewer II (RCD Medicare). Key Responsibilities Perform medical claim reviews for complex services, preauthorization requests, and appeals Determine medical necessity and document rationale for coverage decisions Participate in quality control activities and provide guidance to team members Required Qualifications, Training, and Education Active RN licensure in the state hired or compact multistate RN license Associate degree in Nursing or graduate of an accredited School of Nursing Two years of clinical experience as an RN Working knowledge of word processing software Experience with Microsoft Office tools
A company is looking for an RN Medical Reviewer II (RCD Medicare).
Key Responsibilities
Perform medical claim reviews for complex services, preauthorization requests, and appeals
Determine medical necessity and document rationale for coverage decisions
Participate in quality control activities and provide guidance to team members
Required Qualifications, Training, and Education
Active RN licensure in the state hired or compact multistate RN license
Associate degree in Nursing or graduate of an accredited School of Nursing
Two years of clinical experience as an RN
Working knowledge of word processing software
Experience with Microsoft Office tools
