Medical Review RN

1 week ago


West Columbia, South Carolina, United States InGenesis Full time
Job Title: Medical Review RN

About the Role: InGenesis is seeking a skilled Registered Nurse to join our team as a Medical Review RN. This role involves reviewing and evaluating medical eligibility for benefits, assessing medical necessity, and monitoring services to ensure they align with benefit guidelines.

Responsibilities:
  • Perform medical review/authorization process
  • Evaluate outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit
  • Ensure accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits
  • Utilize allocated resources to back up review determinations
  • Identify and make referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.)

Requirements:
  • Current Registered Nurse/RN license in the State of South Carolina
  • Associate's degree in nursing or graduate from accredited nursing school
  • 2+ years of clinical experience

Estimated Salary: $65,000 - $80,000 per year

About Us: InGenesis is one of the largest staffing firms in the industry and is among the largest diversity-owned healthcare staffing firms in North America. We are dedicated to placing people in positions that preserve life, improve lives, and inspire others.

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