South Carolina Board Of Nursing – RN Medical Reviewer II

South Carolina South Carolina Board of Nursing. Location. Synergy Business Park Kingstree Building 110 Centerview Drive, Suite 202 Columbia, SC 29210. View in Google Maps. Mailing Address P.O. Box 12367 Columbia, SC 29211 Website Visit member website.

The mission of the State Board of Nursing for South Carolina is the protection of public health, safety, and welfare by assuring the safe and competent practice of nursing. This mission is accomplished by assuring safe initial practice as well as continuing competency in the practice of nursing and by promoting nursing excellence in the areas of …

South Carolina Board of Nursing. Phone: (803) 896-4550 Fax: (803) 896-4515 PO Box 12367 Columbia, S.C. 29211-2367. E-mail: [email protected] South Carolina …

South Carolina is a member of the Nurse License Compact; therefore, if you already have a multistate compact license you can practice in South Carolina; $90 fee for a South Carolina nursing license by examination; $100 fee for a South Carolina RN license by endorsement without a temporary license; $110 fee for a South Carolina nursing license …

South Carolina Department of Labor, Licensing, and Regulation Making South Carolina a safe place to work and live. The mission of the Department of Labor, Licensing, and Regulation (LLR) is to promote the health, safety, and economic well-being of the public through …

Notice to graduates of Star College Practical Nursing Program: Please be advised that on September 23, 2020, the Maryland Board of Nursing reviewed documentation regarding the Star College Practical Nursing Program, a PN education program formerly located at 6066 Leesburg Pike, Suite 450, Falls Church, Virginia (a closed nursing program, no longer in operation), and determined that the Star …

South Carolina Board Of Nursing

Is South Carolina a compact nursing state?

South Carolina is a Nursing Licensure Compact state. In South Carolina, Certified Nurse Practitioners, Clinical Nurse Specialists, and Certified Nurse-Midwives may apply for prescriptive authority for controlled substances and schedules III to V in collaboration with physicians.

What are the best nursing schools in SC?

The Best Nursing Schools in South Carolina (SC) in 2018. 1. Charleston Southern University, Charleston, SC. Charleston Southern University is a private university that offers a fantastic Bachelor of Science in Nursing degree.

What is the SC State Board of Nursing?

South Carolina Board of Nursing is the administrative board and council that regulates and enforces public safety and welfare by promoting efficient and legal nurse practicing in the state. Board is an integral member of NCSBN and follows various guidelines specified in the Nurse Practice Act.

What is a nurse compact state?

A nursing compact state is a state that has joined the Nurse Licensure Compact (NLC) after passing legislation that accepts the Compact and incorporating the provisions into the state’s Nurse Practice Act. The NLC is an agreement among member states to honor nurse licensure of other member states for registered and practical/vocational nurses.

RN Medical Reviewer II – Palmetto GBA – BlueCross BlueShield of South Carolina

Summary

Possibility to work remotely once fully trained for residents in South Carolina.
Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines.
Documents decisions using indicated protocol sets or clinical guidelines.
Provides support and review of medical claims and utilization practices.

Job Description

  • 70% Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, correct coding for claims/operations. Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines. Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement. Monitors the process’s timeliness following contractor standards. Documents medical rationale to justify payment or denial of services and/or supplies.
  • 20% Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. by contractor guidelines.
    10% Participates in quality control activities in support of the corporate and team-based objectives. Provides guidance, direction, and input as needed to LPN team members. Provides education to non-medical staff through discussions, team meetings, classroom participation, and feedback. Assists with special projects and specialty duties/responsibilities as assigned by management.

Required Skills and Abilities :

  • Working knowledge of word processing software.
  • Ability to work independently, prioritize effectively, and make sound decisions.
  • Good judgment skills.
  • Demonstrated customer service and organizational skills.
  • Demonstrated oral and written communication skills.
  • Analytical or critical thinking skills.
  • Ability to handle confidential or sensitive information with discretion.

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