Utilization Review Nurse

At BlueCross BlueShield of South Carolina, we are seeking a highly motivated and dedicated Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will be responsible for ensuring that services provided to our members are medically necessary and appropriate for their condition. You will be expected to review medical records and patient data to ensure our members receive the best quality care. The ideal candidate for this role must have a registered nursing license in the State of South Carolina and at least two years of clinical experience. Additionally, you must have a strong working knowledge of insurance and managed care regulations, as well as an understanding of medical terminology. We are seeking someone who is a problem solver, has excellent communication skills, and is comfortable navigating complex medical cases. If you have a passion for helping others and providing quality care, we encourage you to apply. Responsibilities: Review medical records and patient data to ensure that members receive the best quality care. Ensure that services provided to members are medically necessary and appropriate for their condition. Understand and adhere to insurance and managed care regulations. Possess a strong working knowledge of medical terminology. Act as a problem solver and use excellent communication skills to navigate complex medical cases. Provide quality care and assistance to members. Maintain a valid registered nursing license in the State of South Carolina. BlueCross BlueShield of South Carolina is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply Job!