Utilization Review Nurse

Are you a skilled Utilization Review Nurse with experience in medical evaluation and data analysis? BlueCross BlueShield of South Carolina is looking for a motivated professional to join our team and assist in the evaluation of services and resources to ensure quality patient care. In this role, you will be expected to review medical records and procedures to ensure that they meet the organization’s standards. To be successful in this position, you must possess a comprehensive understanding of the health care field, have excellent communication and organizational skills, and be committed to providing superior customer service. If you’re looking for a challenging and rewarding role in the healthcare industry, then this job is for you!

Responsibilities: Evaluate medical records and services to ensure they meet BlueCross BlueShield of South Carolina's standards. Utilize data analysis and medical evaluation skills to ensure quality patient care. Develop and implement strategies to enhance the effectiveness of medical services. Maintain up-to-date knowledge of the healthcare industry and new developments. Collaborate with other healthcare professionals to ensure patient care is carried out effectively. Provide exceptional customer service to internal and external customers. Document and report any discrepancies or irregularities to the appropriate department. Adhere to the organization’s guidelines and procedures.

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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