Utilization Review Nurse

We are looking for a motivated and skilled Utilization Review Nurse to join our team at BlueCross BlueShield of South Carolina. As a Utilization Review Nurse, you will be responsible for assessing the appropriateness and quality of medical services provided to our members. You will have the opportunity to use your clinical experience and expertise to engage with providers, identify potential risks, and ensure the quality of patient care and service delivery.To be successful in this role, you must have a current nursing license and experience working in a managed care and/or utilization review environment. In addition, strong critical thinking and problem-solving skills, as well as excellent organizational and communication abilities, are essential. If you are a passionate and motivated individual seeking to make a difference in the lives of our members, then this role could be a great fit for you.

Responsibilities:

Assess medical services provided to members to ensure appropriate and quality care.
Engage with providers to identify potential risks.
Utilize clinical experience and expertise to ensure the quality of patient care.
Maintain current nursing license.
Utilize managed care and/or utilization review experience to make decisions.
Develop critical thinking and problem-solving skills.
Demonstrate excellent organizational and communication abilities.
Utilize knowledge and resources to make a difference in the lives of members.

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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