On-Site Medical Review Manager - Myrtle Beach

Palmetto GBA, LLC; Myrtle Beach, Northern (SC, KY); Hybrid; USD 90,000 - 115,000; Full time

Benefits offered by this job

On-site cafeterias

Fitness centers

PTO

Education Assistance

Job summary

BlueCross BlueShield of South Carolina is hiring a Medical Review Manager to oversee the processing of deferred medical necessity reviews. The role ensures compliance with national standards and state/federal laws, and leads process improvements within a full-time on-site capacity in Myrtle Beach, SC.

You will manage the medical review workflow, maintain trained staff, and develop strategies to reduce errors while ensuring timely, high-quality decisions and strong provider communication.

Qualifications

• 5 years clinical and utilization review experience, incl 2 years supervision
• RN licensure in state hired or active compact license as defined by NLC
• Bachelor's degree required in the field

Responsibilities

• Manage the medical review process and supervise staff
• Develop/implement medical review strategy to reduce error rate
• Ensure timeliness of reviews and quality of decisions; ensure compliance with standards and laws
• Provide feedback to providers regarding results of medical review and corrective actions
• Investigate inquiries and respond promptly and accurately
• Interface with appellants/attorneys/regulatory bodies to maintain relationships

Skills

Verbal communication

Written communication

Organizational skills

Customer service

Analytical thinking

Presentation skills

Good judgment

Spelling & grammar

Business math

Persuasion

Confidentiality

Government programs

Medical terminology

Legal terminology

Disease management

Litigation processes

Microsoft Office

Education

Nursing degree

RN licensure

Bachelor's degree

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is hiring a Medical Review Manager to oversee the processing of deferred medical necessity reviews. The role ensures compliance with national standards and state/federal laws, and leads process improvements within a full-time on-site capacity in Myrtle Beach, SC.

You will manage the medical review workflow, maintain trained staff, and develop strategies to reduce errors while ensuring timely, high-quality decisions and strong provider communication.