South Carolina RN Medical ReviewerVirtualVocations • Sacramento, California, United States

South Carolina RN Medical Reviewer

VirtualVocations • Sacramento, California, United States

[job_card.variable_days_ago]

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[job_card.full_time]

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

Key Responsibilities

Conducts medical claim reviews for complex services and preauthorization requests

Determines medical necessity and appropriateness for coverage and reimbursement

Educates staff on medical reviews, terminology, and coding procedures

Required Qualifications

Associate Degree in Nursing or graduation from an accredited School of Nursing

Valid, active, unrestricted RN licensure in the state of hire or active compact multi-state RN licensure

Two years of clinical nursing experience

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South Carolina • Sacramento, California, United States

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