Utilization Review Nurse
Are you a Registered Nurse who is passionate about helping patients access quality care? BlueCross BlueShield of South Carolina is looking for an experienced Utilization Review Nurse to join our team. You will need to be organized, have excellent communication skills, and a passion for making a difference.The ideal candidate must have a current Registered Nurse license in South Carolina and at least two years of experience in Utilization Review. You must also have experience with a variety of healthcare documentation systems, the ability to analyze medical data, and excellent problem-solving skills. Knowledge of healthcare policies and procedures, as well as the ability to assess medical necessity, is also essential.This is an exciting opportunity for an experienced Utilization Review Nurse to make a positive impact on patients lives and join a dynamic team of healthcare professionals. If you meet the qualifications outlined above, we would love to hear from you! Responsibilities: Ensure compliance with all applicable laws and regulations, including the South Carolina Board of Nursing regulations Analyze medical data and documents to assess medical necessity of care and services Maintain accurate and up-to-date medical records and patient information Monitor utilization of health care services and evaluate appropriateness of care Review and process prior authorization requests within established guidelines Respond to questions and inquiries from patients, providers, and other stakeholders Collaborate with other departments and medical staff to ensure quality care and service Provide education and guidance to healthcare providers and staff on utilization review processes and procedures Identify and document opportunities for improvement in utilization review processes and procedures Develop and maintain effective working relationships with internal and external stakeholders BlueCross BlueShield of South Carolina is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply Job!