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LPN Medical Reviewer (KS-PV)

Nursing | Columbia, SC | Full Time

Job Description

LPN Medical Reviewer

Columbia SC

 

We have an opportunity for an LPN Medical Reviewer to come and join our client located in Columbia, SC! As the LPN Medical Reviewer with a large health insurance provider, you will be responsible for reviewing and evaluating medical or behavior eligibilities regarding benefits and clinical criteria. You’ll successfully complete these highly important assignments by applying clinical expertise, administrative policies and previous established clinical criteria.  So, if you’re ready to join an organization that serves millions of South Carolinians, apply today!

 

Overall Purpose of the Position:

Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals.  Documents decisions using indicated protocol sets or clinical guidelines.  Provides support and review of medical claims and utilization practices.

This opportunity could give you the ability to work remote once fully trained and performance is in good standing. 

 

Qualifications:

  • Active & unrestricted LPN license in South Carolina  
  • Minimum of 2 years clinical experience
  • Solid computer skills
  • Excellent attention to detail
  • Ability to work independently

 

We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law