Utilization Review Nurse

Are you a passionate and motivated Utilization Review Nurse looking for an opportunity to make a real difference while working in a fast-paced, team-oriented environment? BlueCross BlueShield of South Carolina is seeking an experienced Utilization Review Nurse to provide quality care and excellent customer service. In this role you will be responsible for reviewing, analyzing, and evaluating medical records in order to ensure that the services provided are medically necessary and meet all applicable criteria. As part of our team you will promote clinical and financial outcomes while providing a positive member experience.To be successful in this role, you must possess a current and valid RN license, a minimum of two years of nursing experience in a hospital or clinic setting, and knowledge of medical terminology, coding, and regulatory requirements. In addition, you must have excellent written and verbal communication skills and the ability to work independently. If you are excited about this opportunity and have the qualifications we are looking for, we would love to hear from you!

Responsibilities:

1. Review, analyze and evaluate medical records to ensure services provided are medically necessary and meet all applicable criteria.
2. Promote clinical and financial outcomes while providing a positive member experience.
3. Maintain current and valid RN license and knowledge of medical terminology, coding, and regulatory requirements.
4. Provide excellent customer service to members of the organization.
5. Possess excellent written and verbal communication skills and the ability to work independently.
6. Participate in team meetings and activities to ensure quality care and customer service.
7. Remain up to date on changes in healthcare regulations and practices.
8. Provide support and education to members regarding treatment plans and services.
9. Document all patient care activities accurately and timely.
10. Monitor and evaluate patient care plans to ensure adherence to standards of care.

According to JobzMall, the average salary range for a Utilization Review Nurse in Goose Creek, SC, USA is $72,000 - $95,000 per year. This range can vary depending on factors such as experience, education, and additional certifications.

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.