South Carolina Licensed RN Medical Reviewer

Working remotely in a full-time capacity, the South Carolina Licensed RN Medical Reviewer will perform medical reviews of claims, determine medical necessity, and educate staff on medical terminology and coverage determinations. Key responsibilities Conduct medical claim reviews for complex services, ensuring compliance with established criteria and guidelines Educate internal and external staff on medical reviews, coding procedures, and coverage determinations Participate in quality control activities and provide guidance to LPN team members Required qualifications Associate's degree in a job-related field or equivalent from an accredited nursing school Active RN licensure in South Carolina or a compact multistate RN license Minimum of 2 years of clinical experience Proficiency in Microsoft Office and word processing software Ability to work independently and make sound decisions