- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and ... and determine medical necessity criteria and contract benefits. Collaborates with Care Management and other areas to ensure proper care management processes… more
- ManpowerGroup (Columbia, SC)
- ** Utilization Management Nurse / Social Worker (Contract Position)** **Location:** Remote (Must Train Onsite for 1-2 Weeks) - Must Reside Within 3 Hours of ... PM **Interview Format:** Microsoft Teams **Job Overview** We are seeking a ** Utilization Management Nurse or Licensed Social Worker** to perform medical… more
- US Tech Solutions (Columbia, SC)
- …stable service from your internet provider (non-satellite). + Skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical ... experience and /or UR experience/Process Appeals requests/can have experience in either Utilization management or Appeals + Please list any 'soft skills'… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management /clinical/or combination; 2 of 4 years ... prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. +… more
- Centene Corporation (Columbia, SC)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- US Tech Solutions (Columbia, SC)
- …experience. We want to see all candidates with experience with prior insurance, utilization management , case management , surgical or behavioral health ... care issues. **Experience:** + 2 years clinical experience plus 1 year utilization /medical review, quality assurance, or home health, OR, 3 years clinical.… more
- US Tech Solutions (Columbia, SC)
- …+ Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits ... different programs and work remotely. Detail Oriented, Good Communication Skills, Time Management , Organization, Team Oriented, but able to work independently. + We… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. **Responsibilities:** + Utilizes clinical proficiency and ... education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to ... education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through… more
- Fresenius Medical Center (Columbia, SC)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Humana (Columbia, SC)
- …part of our caring community and help us put health first** The Compliance Nurse Auditor reviews utilization management activities and documentation to ... an acute care, skilled and/or rehabilitation clinical setting + Experience with utilization management , pre-service denials and/or quality assurance audits in… more
- Evolent (Columbia, SC)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- ManpowerGroup (Columbia, SC)
- …**Duration: 3 months** **Rate range: $25 to $30** **Position Overview** The Utilization Review Nurse performs medical or behavioral eligibility reviews to ... By leveraging clinical expertise, administrative policies, and established criteria, the nurse evaluates service requests, supports members in managing their health… more
- ManpowerGroup (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management /clinical/or combination; 2 of the 4 ... **Job Description: Care Management Specialist (Remote)** **Pay Rate: 30/Hr on W2**...for members and providers regarding healthcare delivery systems, network utilization , and benefit plans. 9. Identify and initiate on-site… more
- ManpowerGroup (Columbia, SC)
- …Education: Bachelor's degree- Nursing. Preferred Work Experience: 7 years-healthcare program management , utilization review, or clinical experience in defined ... established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to… more
- Pilgrim's (Sumter, SC)
- …and within the scope of practice and regulation of the State Nurse Practice Act. Directs, administers, supervises, and evaluates site Occupational Health service ... of policy and quality of nursing care. Ensures adherence to health management protocols, medical directives, policies and procedures, and physician standing orders… more
- Humana (Columbia, SC)
- …professional development. Training programs may include, but not be limited to, Care Management , Utilization Management , and/or Compliance. RN licensure is ... Master of Science in Nursing with a focus on nursing education. + Licensed Registered Nurse (RN) in the state where you reside with no disciplinary action + 5 years… more
- Fresenius Medical Center (Columbia, SC)
- …dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care in the dialysis clinic. ... data collections and auditing activities. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. +… more