Senior Medical Reviewer, Medicare Part B
BlueCross BlueShield of South Carolina
Clinical Reviewer, Nurse
Evolent
full-time
Posted on:
Location Type: Remote
Location: Remote • California • 🇺🇸 United States
Visit company websiteSalary
💰 $32 - $37 per hour
Job Level
Mid-LevelSenior
About the role
- The Nurse Reviewer is responsible for performing precertification and prior approvals.
- Performs utilization review of outpatient procedures and ancillary services.
- Determines medical necessity and appropriateness of services using clinical review criteria.
- Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum.
Requirements
- Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license.
- High School Diploma or equivalent required
- Minimum of three years of direct clinical patient care
- Minimum of one year of experience with medical management activities in a managed care environment.
Benefits
- health insurance benefits
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization reviewclinical review criteriamedical necessity determinationprecertificationprior approvalsoutpatient procedures reviewancillary services review
Soft skills
collaborationcommunication
Certifications
Registered Nurse licenseLicensed Practical Nurse licenseLicensed Vocational Nurse license
