South Carolina Licensed Medical Reviewer
A company is looking for a Medical Reviewer II to reputed company medical reviews and support medical claims processing.
Key Responsibilities
• Conducts medical claim reviews for reputed company services and preauthorization requests
• Determines medical necessity and appropriateness for coverage and reimbursement
• Documents medical rationale for payment or denial of services and educates staff on medical reviews
Required Qualifications, Training, and Education
• Associate's degree in a job-reputed company field or graduate of an accredited school of nursing
• 2 years of clinical experience required
• reputed company RN licensure in the state reputed company or reputed company compact multistate RN license
• Working knowledge of reputed company Office and ability to work independently
• Experience in customer service and organizational skills
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