RN Medical Reviewer III (W@H South Carolina)

Required Education: Associates in a job-related field Degree Equivalency: Graduate of Accredited School of Nursing Required Experience: 2 years clinical plus 1 year utilization/medical review, quality assurance, or home health, OR 3 years clinical. FOR PALMETTO GBA (CO. 033) ONLY: 2 years clinical experience plus 2 years utilization/medical review, quality assurance, or home health experience. Required Skills and Abilities: Working knowledge of managed care and various forms of health care delivery systems; strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience. Knowledge of specific criteria/protocol sets and the use of the same. Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, current active, unrestricted licensure/certification from the United States and in the state of hire in specialty area as required by hiring division/area. What We Prefer You to Have: Preferred Education: Bachelor's Degree-Nursing or Graduate of accredited School of Nursing. Preferred Work Experience: Must have well rounded clinical experience. Preferred Work Experience: 3 years’ utilization/medical review, quality assurance, or home health, plus 5 years clinical experience. Preferred Skills and Abilities: Knowledge of spreadsheet and database software. Knowledge of Medicare and/or regulations/policies/instructions/provisions, home health, and/or system/processing procedures for medical review. Preferred Software and Other Tools: Working knowledge of Microsoft Excel, Access, or other spreadsheet database software.

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