Employer Industry: Healthcare Consulting

Why consider this job opportunity:
- Salary up to $95/hour depending on experience
- Opportunity to contribute to a multi-year project focused on Medicaid Management Information System enhancements
- Potential for career advancement within a government agency
- Collaborative work environment with opportunities to work with various stakeholders
- Chance to utilize and expand clinical knowledge and expertise in a meaningful way
- Hybrid work model with 25% onsite requirement in Columbia, SC

What to Expect (Job Responsibilities):
- Review and interpret patient records to assess medical necessity and appropriateness of care
- Maintain knowledge of medical coding and collaborate with team members to ensure compliance with guidelines
- Collaborate with agency employees and external stakeholders to improve claims-related outcomes
- Participate as a project team member for process improvements and MMIS enhancements
- Perform other project-related duties as assigned

What is Required (Qualifications):
- Current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse
- Minimum of 2 years of healthcare experience in Utilization Reviews and/or Prior Authorization
- At least 1 year of experience working with IT developers/programmers in a payor environment
- Knowledge of Medicare and/or Medicaid regulations
- Strong knowledge of formal business process documentation

How to Stand Out (Preferred Qualifications):
- Strong clinical assessment and critical thinking skills
- Knowledge of medical records organization, medical terminology, and disease processes
- Excellent verbal and written communication skills
- Flexibility and strong organizational skills
- Proficiency in Microsoft Office and internet/web navigation

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