Utilization Review Nurse

BlueCross BlueShield of South Carolina is seeking an experienced and motivated Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will be responsible for assessing patient care and making sure that it meets the organization's standards of quality and cost-efficiency. You will also be an integral part of the healthcare team, collaborating with physicians, case managers, and other healthcare professionals to coordinate and review medical treatment plans.To be successful in this role, you must have a current Registered Nurse (RN) license as well as at least three years of experience in healthcare utilization review, case management, or other related fields. You should also have excellent communication and problem-solving skills, as well as a strong understanding of healthcare regulations.If you are a dedicated and experienced professional looking to make a difference in the lives of our patients and their families, we encourage you to apply for the Utilization Review Nurse position at BlueCross BlueShield of South Carolina.

Responsibilities:

Assess patient care to ensure it meets quality and cost-efficiency standards.

Collaborate with physicians, case managers, and other healthcare professionals to coordinate and review medical treatment plans.

Develop and monitor utilization review policies, procedures, and protocols.

Communicate with external providers to ensure proper authorization and use of services.

Monitor and report on utilization trends and outcomes.

Ensure compliance with applicable regulations and accreditation standards.

Proactively identify areas of potential risk and provide recommendations for improvement.

Maintain current knowledge of healthcare regulations and industry trends.

Maintain patient confidentiality and respect patient rights.

Provide education and guidance to healthcare providers on utilization review processes.

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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