Utilization Review Nurse

At BlueCross BlueShield of South Carolina, we are seeking a highly motivated and dedicated Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will be responsible for ensuring that services provided to our members are medically necessary and appropriate for their condition. You will be expected to review medical records and patient data to ensure our members receive the best quality care. The ideal candidate for this role must have a registered nursing license in the State of South Carolina and at least two years of clinical experience. Additionally, you must have a strong working knowledge of insurance and managed care regulations, as well as an understanding of medical terminology. We are seeking someone who is a problem solver, has excellent communication skills, and is comfortable navigating complex medical cases. If you have a passion for helping others and providing quality care, we encourage you to apply.

Responsibilities:

1. Review medical records and patient data to ensure that members receive the best quality care.
2. Ensure that services provided to members are medically necessary and appropriate for their condition.
3. Understand and adhere to insurance and managed care regulations.
4. Possess a strong working knowledge of medical terminology.
5. Act as a problem solver and use excellent communication skills to navigate complex medical cases.
6. Provide quality care and assistance to members.
7. Maintain a valid registered nursing license in the State of South Carolina.

According to JobzMall, the average salary range for a Utilization Review Nurse in Summerville, SC, USA is $50,000 - $80,000 per year.

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. BlueCross serves 21.5 million people through private business and government contracts.