Utilization Review Nurse

We are looking for an experienced and highly motivated Utilization Review Nurse to join our team at BlueCross BlueShield of South Carolina. In this important role, you will be responsible for ensuring that health care services provided to our members are appropriate, medically necessary, and of the highest quality. You will also work closely with providers to ensure that our members receive the best care possible.To be successful in this position, you must have a current nursing license and a Bachelor?s degree in Nursing. You should also have experience in utilization management, case management, and/or discharge planning. Equally important is your passion for helping others and commitment to providing excellent customer service. If you have these qualifications and are looking for an exciting and rewarding opportunity, we'd love to hear from you!

Responsibilities: Review and evaluate all health care services provided to members to ensure appropriateness, medical necessity, and quality. Collaborate with providers to ensure members receive the best care possible. Provide utilization management, case management, and discharge planning services. Provide excellent customer service to members. Monitor and ensure compliance with all state and federal regulations related to utilization review and health care services. Participate in internal and external meetings and committees to ensure quality care and services. Prepare and submit reports related to utilization review activities. Maintain current knowledge of utilization management practices and standards. Remain current on all applicable laws, regulations, and standards of practice. Develop and implement strategies to improve utilization review processes.

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.

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