Utilization Review Nurse

We at BlueCross BlueShield of South Carolina are looking for an experienced, compassionate Utilization Review Nurse to join our team! The successful candidate will be responsible for reviewing medical services for members to ensure best practice and quality of care. This position requires a detailed, analytical approach to ensure accurate and effective utilization of resources. To be successful in this role, you should have extensive knowledge of medical treatments and procedures, as well as a commitment to providing quality care. You should also have strong interpersonal and communication skills, be able to work independently, and be comfortable working with sensitive information.The ideal candidate should have the following qualifications: • Bachelor’s degree in nursing (BSN) • Active Registered Nurse (RN) license in South Carolina • At least 3 years of experience in Utilization Review • Knowledge of medical terminology and conditions • Knowledge of quality assurance guidelines • Excellent communication and interpersonal skills • Ability to work independently and as part of a team • Excellent problem-solving and critical thinking skills • Proficiency in Microsoft Office

Responsibilities: • Review medical services for members to ensure best practice and quality of care. • Ensure accurate and effective utilization of resources. • Analyze medical treatments and procedures to provide quality care. • Communicate effectively with members and other medical professionals. • Work both independently and as part of a team. • Utilize problem-solving and critical thinking skills. • Maintain proficiency in Microsoft Office and medical terminology. • Adhere to quality assurance guidelines.

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.

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