South Carolina Licensed Clinical Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse.

Key Responsibilities

• Act as a liaison for statewide appeals and ensure compliance with State and NCQA requirements
• Review clinical information to determine medical necessity and prepare response letters for appeals
• Coordinate Fair Hearings and maintain files and logs for all appeals

Required Qualifications

• RN with 4+ years of clinical nursing or case management experience, or LPN/LVN with 5+ years of clinical nursing or case management experience
• Managed care or utilization review experience preferred
• Must hold a valid LPN, LVN, or RN license
• Knowledge of NCQA and State regulations is essential
• Must reside in South Carolina