Remote RN Medical Reviewer II - Claims & Utilization

Palmetto GBA, a Blue Cross Blue Shield of South Carolina subsidiary, seeks an experienced RN for medical claims review and utilization management. This full-time role is remote with training in SC/AL and standard business hours.

You will assess medical necessity, document rationale, and educate staff on coding, coverage determinations, and guidelines, while supporting quality control and process improvements. Travel to onsite training is limited and accommodations are provided where needed.

The Remote RN Medical Reviewer II
- Claims & Utilization position in the Bio & Pharmacology & Health field is open for applications.

Take a moment to read everything above and see whether this role is right for you.

This posting is for the Remote RN Medical Reviewer II
- Claims & Utilization role , based in United States.