Remote Medical Reviewer - Utilization & Claims

Spectraforce Technologies, Inc.; Columbia (SC); Remote; USD 42,000 - 59,000; Full time

Job summary

Spectraforce Technologies, Inc. is seeking a Medical Reviewer I to perform medical reviews and utilization management in a remote-capable role based in Columbia, SC.

The position starts with onsite training and transitions to remote work after 1–2 weeks, with a Mon-Fri schedule and EST hours. Qualified candidates will have a healthcare background, licensure options (LPN/LVN or RN, or social work background), and at least two years of clinical experience.

Qualifications

• Requires Bachelor's degree in Social Work or nursing licensure.
• LPN/LVN or RN licensure with US state authorization preferred.
• Clinical experience of at least 2 years required.
• Strong documentation and communication skills essential.

Responsibilities

• Perform medical claim reviews and utilization management.
• Ensure timely processing and accurate documentation of determinations.
• Educate staff and providers on medical review processes and terminology.
• Participate in quality control and training activities.

Skills

Analytical thinking

Customer service

Attention to detail

Communication skills

Discretion with confidential info

Education

Bachelor's degree - Social Work

LPN/LVN diploma

Associate degree in Nursing

Tools

Microsoft Office

Job description

Spectraforce Technologies, Inc. is seeking a Medical Reviewer I to perform medical reviews and utilization management in a remote-capable role based in Columbia, SC.

The position starts with onsite training and transitions to remote work after 1–2 weeks, with a Mon-Fri schedule and EST hours. Qualified candidates will have a healthcare background, licensure options (LPN/LVN or RN, or social work background), and at least two years of clinical experience.