- CVS Health (Columbia, SC)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment… more
- Evolent Health (Columbia, SC)
- …value proposition and outcomes that effectively support these programs. + Collaborates with UM Director and Quality Management to develop, implement and maintain ... department. The UM Lead, in collaboration with the UM Manager and Director , ensures compliance with all regulatory standards that include state, federal,… more
- ManpowerGroup (Columbia, SC)
- **Title:** **Managed Care Coordinator UM II** **Location: Columbia SC (Onsite)** **Duration: 3 months** **Pay Range : $31/hr (On W2)** We are looking for a " ... **Managed Care Coordinator UM II** "to join one of our Fortune 500...determinations. Identifies and makes referrals to appropriate staff (Medical Director , Case Manager, Preventive Services, Subrogation, Quality of care… more
- CVS Health (Columbia, SC)
- …health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying our Models of Care ... physical, behavioral and socioeconomic needs. * Partner closely with the Executive Director of Duals and other Duals Care Management leadership to collaborate across… more
- CVS Health (Columbia, SC)
- …more personal, convenient and affordable. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout this ... the Southeast Region (KY, LA and WV). This Medical Director will be a "Work from Home" position primarily...Pediatrics, Internal Medicine-Pediatric, Family Medicine Specialty Preferred. - Prior UM experience working at Health Plan / Insurer or… more
- Evolent Health (Columbia, SC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** **Senior Director , Partner Operations** The Senior Director , Partner Operations serves as ... the go-to expert on client priorities. **Collaboration Opportunities** The Senior Director , Partner Operations role also collaborates with internal teams as… more
- Evolent Health (Columbia, SC)
- …Stay for the culture. **What You'll Be Doing:** As a Behavioral Health Field Medical Director will be a key member of the utilization management team. We can offer ... Evolent Health is looking for a Behavioral Health Medical Director to be a member of the Evolent clinical...health plan medical policies, and appropriate Care Management and UM goals and objectives + Population health - collaborative… more
- Evolent Health (Columbia, SC)
- …a growth mindset as we solve complex business problems. **Collaboration Opportunities** The Director , Client Analyst role will be serving as a strategic advisor to ... medical, pharmacy and ancillary claims data, membership data, clinical operational data ( UM & CM), or other healthcare data- **Required.** + Familiarity with Power… more
- Prime Therapeutics (Columbia, SC)
- …Prime's functional areas: Clinical Program Management, Utilization Management ( UM ), Formulary, GuidedHealth, Pharmaceutical Trade Relations, Pharmacy Audit, Provider ... and process support for Prime National and Client Utilization Management ( UM ) programs, review of regulatory requirements and adherence for processes related… more
- ManpowerGroup (Columbia, SC)
- …clients. **Note:-** + Must Have Behavioral Health Experience + Previous Utilization Management ( UM ) or Case Management (CM) experience + Training will be onsite & ... determinations. + Identifies and makes referrals to appropriate staff (Medical Director , Case Manager, Preventive Services, Subrogation, Quality of Care Referrals,… more