Medical Review Manager

## Medical Review Manager Apply:
On-site:
Myrtle Beach, South Carolina:
Full time:
Posted Today:
End Date:
September 28, 2026 (4 days left to apply):
R1051457#
** Summary
* * We are currently hiring for a Medical Review Manager to join Blue Cross Blue Shield of South Carolina. In this role as a Medical Review Manager, you will oversee the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identifies and implements process improvement opportunities.#

** Description
* * Why should you join the Blue Cross Blue Shield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts.

We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
** Position

Purpose:

** We are currently hiring for a Medical Review Manager to join Blue Cross Blue Shield of South Carolina. In this role as a Medical Review Manager, you will oversee the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identifies and implements process improvement opportunities.

** Logistics:**   - one of Blue Cross Blue Shield of South Carolina’s subsidiary companies.

*
* Location:

** This position is full-time (40-hours/week) Monday-Friday from
** 8:00am-5:00pm
** and will be
** on-site
** in
** Myrtle Beach, SC.*
* *
* What You’ll Do:

*** Manages the medical review process. Maintains a well-trained staff. Develops/implements medical review strategy with the ultimate goal of reducing the error rate. Ensures timeliness of review, quality of decisions, set productivity levels, and compliance with all nationally recognized standards, and local/state/federal laws and regulations. Identifies missed standards and implements corrective actions.
* Provides comprehensive and accurate feedback to provider community regarding results of medical review and correction action. Investigates all internal and external inquiries and ensures they are responded to in a timely and accurate manner.
* Interfaces with internal and external customers such as appellants/attorneys, congressional offices , and other regulatory bodies as required to build and maintain positive customer relationships.  
** To Qualify for This Position, You'll Need the Following:**
* ** Required

Education:

** Associate's in a job related field (Bachelor's degree required for the Celerian Group).
* ** Degree Equivalency:
** Graduate of Accredited School of Nursing (Equivalency not applicable for the Celerian Group or Palmetto GBA. Bachelor's degree required.)
* ** Required

Work Experience:

** 5 years clinical and utilization review to include 2 years supervisory or team lead experience or equivalent military experience in grade E4 or above.
* ** Required

Skills and Abilities

**:
Excellent verbal and written communication, organizational, customer service, analytical or critical thinking, and presentation skills.
* Good judgment skills.
* Proficient spelling, grammar, punctuation, and basic business math.
* Ability to persuade, negotiate or influence, and handle confidential or sensitive information…