- ManpowerGroup (Columbia, SC)
- **Job Title: Medical Claims Reviewer ** **Pay Rate:23/Hr (REMOTE opportunity after training)** **Duration:3+ Months on W2** **Location:4101 Percival Road Columbia ... United States and in the state of hire. **Job Description:** As a Medical Claims Reviewer /Utilization Management Specialist, you will be responsible for… more
- ManpowerGroup (Columbia, SC)
- **Title: Medical Reviewer ** **Location:** **4101 Percival Road Columbia SC 29229 US (Onsite)** **Duration: 03+ Month's Contract** **Shift: Monday to Friday, 8 AM ... Range $20.00 to $23.00/hr.** We are looking for a " Medical Reviewer " to join one of our...one of our Fortune 500 clients. **Job Summary** The Medical Review and Utilization Management Specialist is… more
- Prime Therapeutics (Columbia, SC)
- …**Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the ... Initial Clinical Reviewers as needed to discuss cases and problems. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the MD… more
- Evolent Health (Columbia, SC)
- …Stay for the culture. **What You'll Be Doing:** As a Pain Management Clinical Reviewer , Nurse, you will be a key member of the utilization management team. We ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact with leadership and management… more
- ManpowerGroup (Columbia, SC)
- …**Education and Communication (10%)** : + Educate internal and external staff on medical review protocols, coverage determinations, and coding procedures in line ... **Position: Medical Claims Review Specialist** **Location: Columbia SC** **Duration :3+ months** **Pay Rate: $24/hr on W2** **We are looking for a** ** Medical… more
- Evolent Health (Columbia, SC)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of...Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet… more
- Sedgwick (Columbia, SC)
- …Best-in-State Employer Specialist Bill Review II **PRIMARY PURPOSE** : To review hospital and professional medical bills from provider including complex ... preferred. Two (2) years of experience with complex medical , legal, and consult review preferred. **Skills & Knowledge** + Knowledge of re-pricing rules… more
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... healthcare needs of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying… more
- Prime Therapeutics (Columbia, SC)
- …has managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key role in medical and pharmacy management. ... and drives every decision we make. **Job Posting Title** Supervisor Clinical Pharmacist Review - Remote in California **Job Description Summary** This position… more
- Sedgwick (Columbia, SC)
- …Most Loved Workplace(R) Forbes Best-in-State Employer Physical Therapy Utilization Review Advisor **PRIMARY PURPOSE** **:** Counsels providers (physical therapists, ... the impact of physical therapy services provided to injured workers; provides medical necessity reviews to evaluate and implement services to meet client health… more
- Sedgwick (Columbia, SC)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Careworks Bill Review - Product Owner **PRIMARY PURPOSE** **:** Directs the independent bill ... review product for clients and external partners providing project...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- SitusAMC (Columbia, SC)
- …will identify questions/issues that may be arising throughout the course of a review or multiple reviews and work with Training to ensure that these questions ... the start of a new engagement, the role will review a sample of the file(s) from the engagement...the engagement to ensure the deal setup and any reviewer instructions are accurate. If problems are identified, the… more
- Wilson Language Training (Columbia, SC)
- …Job Functions:** + Manages state-level submissions for program adoption or review : + Supports strategic planning of state-level responses. + Identifies, tracks, ... components focused on Wilson programs and professional learning, such as reviewer -s guides, program summaries, and other background information. + Consults with… more
- Terracon (Columbia, SC)
- …of plans and specifications, observation and inspection, and the writing, preparation, and review of related reports for the services provided. Review drawings ... and recommend changes. Research and resolve design and construction problems. Assign, review , and evaluate laboratory or field data for inclusion in reports. Apply… more
- Highmark Health (Columbia, SC)
- …and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- Humana (Columbia, SC)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Humana (Columbia, SC)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... health insurance, other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage and… more
- Merck (Columbia, SC)
- **Job Description** The Medical Writing & Disclosure Department of the GCTO organization prepares a variety of regulated documentation in support of the clinical ... disclosure, and data sharing with external researchers. The Specialist (Disclosure Medical Writer) will be primarily responsible for preparing clinical study… more
- Merck (Columbia, SC)
- **Job Description** The Executive Director, Value & Implementation (V&I), Global Medical and Scientific Affairs (GMSA) is accountable for the development and ... execution of scientific & medical affairs plans for Ophthalmology). They build and lead...+ Supports the Investigator-Initiated Study program + Leads talent review process and demonstrates follow-through on Development Plans for… more
- CVS Health (Columbia, SC)
- …Management staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for ... from home) role and m** **ust have a California medical license and be willing to obtain an Arizona... license and be willing to obtain an Arizona medical license.** Preferred candidates will have Internal Medicine or… more