Employer Industry: Healthcare Consulting

Why consider this job opportunity:
- Opportunity for career advancement and growth within a supportive healthcare consulting environment
- Engaging in a multi-year project focused on improving Medicaid services and operations
- Collaborate with a strong clinical team and enhance your expertise in medical coding and regulations
- Chance to make a meaningful impact on Medicaid members and providers
- Required licensure and degree are supported by ongoing professional development opportunities

What to Expect (Job Responsibilities):
- Perform medical record and claims review to ensure compliance with medical necessity criteria
- Review and interpret patient records to determine appropriateness of care
- Maintain knowledge of SC Medicaid Policies and collaborate with team members to adjust processes as needed
- Work with agency employees and external stakeholders to improve claims-related outcomes
- Engage in 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 collaborating with IT developers/programmers in a payor environment
- Knowledge of Medicare and/or Medicaid regulations
- Strong medical record abstracting skills

How to Stand Out (Preferred Qualifications):
- Strong clinical assessment and critical thinking skills
- Familiarity with 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

#HealthcareConsulting #Medicaid #RegisteredNurse #CareerGrowth #ClinicalExpertise

We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.