Utilization Review Nurse

BlueCross BlueShield of South Carolina is seeking a talented Utilization Review Nurse to join our team! In this role, you will be responsible for ensuring the appropriate utilization of healthcare services and resources for BlueCross BlueShield members. You will review medical records and claims and consult with providers to ensure that medical services are appropriate and necessary. You will also be responsible for helping to ensure that our members receive the best possible care.To be successful in this role, you must be a Registered Nurse with a valid nursing license. Additionally, you must have several years of clinical nursing experience in an acute care setting and have a thorough understanding of medical terminology, coding, and reimbursement processes. Experience with utilization review, case management, or quality assurance is preferred.You must also be highly organized and have excellent communication and interpersonal skills. In addition, you must be able to work effectively with members, providers, and other healthcare personnel in order to ensure the best possible care.If you are an experienced nurse with a passion for helping others, we want to hear from you!

Responsibilities: Review medical records and claims to ensure the appropriate utilization of healthcare services and resources for BlueCross BlueShield members. Consult with providers to ensure that medical services are appropriate and necessary. Help to ensure that members receive the best possible care. Remain up to date on medical terminology, coding, and reimbursement processes. Assist with utilization review, case management, or quality assurance processes. Maintain organization and communicate effectively with members, providers, and other healthcare personnel. Ensure compliance with all applicable laws, regulations, and procedures.

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!