RN Medical Reviewer II – Palmetto GBA

Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Description Logistics: Palmetto GBA – one of BlueCross BlueShield’s South Carolina subsidiary companies. Centers for Medicare and Medicaid Services (CMS) Requirements: Certain divisions wi…