South Carolina Licensed RN Medical Reviewer
Company: VirtualVocations
Location: Florissant
Posted on: April 24, 2025
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Job Description:
A company is looking for a RN Medical Reviewer III to perform
medical reviews and support medical claims and utilization
practices.
Key Responsibilities
Conducts medical claim reviews and determines medical necessity
based on clinical information and established guidelines
Educates internal and external staff on medical reviews,
terminology, and coverage determinations
Participates in quality control activities and provides guidance to
team members
Required Qualifications, Training, and Education
Associates degree in a job-related field or graduate of an
accredited School of Nursing
2 years of clinical experience plus 1 year in utilization/medical
review, or 3 years of clinical experience
Active, unrestricted RN licensure in the state of hire or compact
multistate RN license
Working knowledge of managed care and healthcare delivery
systems
Proficient in Microsoft Office software
Keywords: VirtualVocations, Jefferson City , South Carolina Licensed RN Medical Reviewer, Healthcare , Florissant, Missouri
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