- ContinueCARE Hospital at Palmetto Health Baptist (Columbia, SC)
- …Risk Manager Monitor compliance with the safety plans within the Environment of Care Management Program Collects data, prepares and provides reports as requested ... state laws, federal laws, and regulatory agency requirements for hospitals regarding utilization and quality management . Assist /CEO in developing Medical Staff… more
- AmeriHealth Caritas (Columbia, SC)
- … Care Connector is responsible for supporting the daily operations of integrated care management and utilization management program interventions. The ... care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral… more
- Evolent Health (Columbia, SC)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Humana (Columbia, SC)
- …designing solutions for key Medicaid programs and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , ... **,** 5+ years of experience in strategy consulting supporting Medicaid managed care clinical strategy and population health management strategy. + 5+… more
- Humana (Columbia, SC)
- …a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Humana (Columbia, SC)
- …are addressed. They will work closely with established functions inside utilization management (Medical Director, clinician decision making teams, quality ... verbal communication **Preferred Qualifications** + Registered Nurse + Experience in Medicare Utilization Management + Project Management Professional (PMP)… more
- CVS Health (Columbia, SC)
- …Director will be responsible for provider education regarding best clinical practices, utilization management , care management , claims adjudication, ... Health Services strategies, policies, and programs are comprised of utilization management , quality management , network...or comorbid medical conditions. + Coordinates with the MCOs' care management staff and providers on medical… more
- Highmark Health (Columbia, SC)
- …on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of ... Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- Marriott (Columbia, SC)
- …States **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** The Director of Privileged Access Management ... (PAM) leads and executes the company's Privileged Access Management program. This leadership role is responsible for the strategic planning, development, and… more
- ManpowerGroup (Columbia, SC)
- …our Fortune 500 clients. **Note:-** + Must Have Behavioral Health Experience + Previous Utilization Management (UM) or Case Management (CM) experience + ... as member advocate through continued communication and education. + Promotes enrollment in care management programs and/or health and disease management … more
- Veterans Affairs, Veterans Health Administration (Columbia, SC)
- …external customers, and accreditation stakeholders. Meet goals through efficient, effective utilization and management of organizational and personal resources. ... on an as-needed basis until positions filled. Responsibilities This RN Quality Management Accreditation Specialist must have an attitude focused on building a… more
- US Tech Solutions (Columbia, SC)
- …Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management ... work with the concurrent nurses as well as case management . * We also work very closely with our...direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and… more
- Cardinal Health (Columbia, SC)
- …team is passionate about helping oncology practices navigate the future. The Director, Managed Care is responsible for strategy and management of managed care ... and physician leadership demonstrating financial analysis of current and proposed managed care contract performance and utilization . + Provide input to finance… more
- Prime Therapeutics (Columbia, SC)
- …(ABIM/ABOIM). + Familiarity with the principles and procedures of utilization management as practiced in managed care organizations, experience with cost ... Physician Clinical Reviewer- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service… more
- CVS Health (Columbia, SC)
- … in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to ... programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. - Directors… more
- Sharecare, Inc. (Columbia, SC)
- …goals and objectives of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and ... Provider (PCP), and all other members of the health care team to support appropriate total healthcare management... care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager.… more
- Prime Therapeutics (Columbia, SC)
- …support to one or more of Prime's functional areas: Clinical Program Management , Utilization Management (UM), Formulary, GuidedHealth, Pharmaceutical Trade ... or ExCPT (CPhT)** + 3 years of PBM, Managed Care or Pharmaceutical/Trade experience + Project Management ... skills + Knowledge or experience with formulary or utilization management + Proficient in MS Access… more
- CVS Health (Columbia, SC)
- …Medical Director (Behavioral Health) you will: * Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care ... issues * Provide leadership and day-to-day physician oversight for utilization management team, including the management...staff * Participate in the triage and referral for care management * provide coverage for appeals… more
- Evolent Health (Columbia, SC)
- …Doing:** As a Cardiology, Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- CVS Health (Columbia, SC)
- …of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at ... accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. **Position Summary** The Lead Director of… more
