South Carolina Licensed RN Reviewer

A company is looking for an RN Medical Reviewer II to perform medical reviews and support medical claims processing.

Key Responsibilities

Conduct medical claim reviews for complex services and determine coverage and reimbursement based on established criteria

Document medical rationale for payment or denial of services and provide education on medical reviews and coding procedures

Participate in quality control activities and assist with special projects as assigned by management

Required Qualifications, Training, and Education

Associate Degree in Nursing or graduate of an accredited School of Nursing

Two years of clinical experience

Active RN licensure in the state hired or an active compact multistate RN license

Preferred experience in medical review or utilization review

Proficient in Microsoft Office