RN Medical Reviewer III (W@H SC)
BlueCross BlueShield of South Carolina · United States · US
Utilization Review
Remote
physician
Nurse
Dentist
Demand78
Career growth65
Healthcare fit84
Remote potential85
5-year outlook
Payer-side utilization review nursing roles typically offer stable compensation with moderate growth into lead reviewer, quality, or utilization management positions; exact salary depends on market and experience.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-07
Intelligence details
Flexible work details
- Side income
- Classified as side-income friendly
- Engagement type
- Contract
- Hours
- Variable hours
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse, Dentist
- Rate period
- Annual
Why this was classified this way
- contractor
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth applying for RNs seeking a remote, non-bedside payer role with predictable hours and utilization review exposure; less suitable for new nurses or those without active RN licensure.
Who should apply
Experienced RNs with med-surg, home health, rehabilitation, quality assurance, or utilization review backgrounds, especially those with compact licenses and interest in managed care.
CV angle
Frame clinical experience around medical necessity, criteria application, care coordination, documentation, quality assurance, and independent decision-making; highlight any utilization review, appeals, coding, or managed care exposure.
Skills to highlight
- Utilization review
- Medical necessity determination
- Claims review
- Managed care
- Clinical documentation
- Quality assurance
- Coding knowledge
- Communication and negotiation
Role summary
An RN Medical Reviewer III performs medical claim and utilization reviews for a BlueCross BlueShield plan, applying clinical guidelines to determine coverage, medical necessity, and reimbursement, with remote work after initial on-site training.
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