South Carolina Licensed Medical Reviewer

Company: VirtualVocations
Location: Canton
Posted on: April 12, 2025

Job Description:

A company is looking for a Registered Nurse - Medical Reviewer II (RCD Medicare).
Key Responsibilities

Review medical claims to determine medical necessity and eligibility under RCD guidelines
Document medical rationale for payment or denial of services and educate staff on medical reviews and coding procedures
Participate in quality control activities and provide guidance to team members

Required Qualifications

Active RN licensure in the state hired or active compact multistate RN license
Associate degree in Nursing or graduate of an accredited School of Nursing
Two years of clinical experience as an RN
Working knowledge of word processing software and ability to work independently
Demonstrated customer service and organizational skills

Keywords: VirtualVocations, Youngstown , South Carolina Licensed Medical Reviewer, Healthcare , Canton, Ohio

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