Job Description
Our client, a leader in the healthcare industry, is seeking a Reviewer III, Medical to join their team. As a Reviewer III, Medical, you will be part of the Utilization Management department supporting the medical review team. The ideal candidate will have strong analytical skills, excellent communication abilities, and a commitment to quality, which will align successfully in the organization.
Job Title: Reviewer III, Medical
Location: Columbia, SC (REMOTE)
Pay Range: Up to $30.00 per hour
What's the Job? - Perform medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines.
- Document decisions using indicated protocol sets or clinical guidelines and provide support and review of medical claims and utilization practices.
- Educate internal/external staff regarding medical reviews, medical terminology, coverage determinations, and coding procedures.
- Participate in quality control activities in support of corporate and team-based objectives.
- Assist with special projects and specialty duties/responsibilities as assigned by management.
What's Needed? - Associate Degree in Nursing, or a 4-year degree in a health-related field, or a Master's Degree in Occupational Therapy, Physical Therapy, Social Work, Psychology, or Counseling.
- 2 years of clinical experience plus 1 year in utilization/medical review, quality assurance, or home health, or 3 years of clinical experience.
- Active, unrestricted RN licensure from the United States and in the state of hire, or an active compact multistate unrestricted RN license.
- Strong clinical experience, including home health, rehabilitation, and/or broad medical surgical experience.
- Proficiency in Microsoft Office and the ability to handle confidential or sensitive information with discretion.
What's in it for me? - Opportunity to work in a dynamic and supportive environment.
- Gain valuable experience in medical reviews and utilization management.
- Collaborate with a team of dedicated professionals committed to quality healthcare.
- Potential for modified hours once deployed to remote status.
- Onsite training provided for the first 8 weeks to ensure your success in the role.
If this is a role that interests you and you'd like to learn more, click apply now and a recruiter will be in touch with you to discuss this great opportunity. We look forward to speaking with you!
About ManpowerGroup, Parent Company of: Manpower, Experis, Talent Solutions, and Jefferson Wells ManpowerGroup® (NYSE: MAN), the leading global workforce solutions company, helps organizations transform in a fast-changing world of work by sourcing, assessing, developing, and managing the talent that enables them to win. We develop innovative solutions for hundreds of thousands of organizations every year, providing them with skilled talent while finding meaningful, sustainable employment for millions of people across a wide range of industries and skills. Our expert family of brands -
Manpower, Experis, Talent Solutions, and Jefferson Wells - creates substantial value for candidates and clients across more than 75 countries and territories and has done so for over 70 years. We are recognized consistently for our diversity - as a best place to work for Women, Inclusion, Equality and Disability and in 2023 ManpowerGroup was named one of the World's Most Ethical Companies for the 14th year - all confirming our position as the brand of choice for in-demand talent. Experis
Job Tags
Hourly pay, Remote job,