- US Tech Solutions, Inc. (Columbia, SC)
- …PREFERRED/NICE TO HAVE skill sets/qualities: I would love to have someone with prior insurance/ utilization review experience, but I know that is not very common. ... Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient,...any of the following in support of medical claims review and utilization review practices:… more
- Humana (Columbia, SC)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... 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… 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 ... prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. +… more
- Lincoln Financial Group (Columbia, SC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- PruittHealth (Columbia, SC)
- **JOB PURPOSE:** Senior Nurse Consultant serves as a member of the clinical and region team, to assist centers in achieving clinical excellence. She/he is ... operations and quality improvement practices for designated centers. The senior nurse consultant provides education, mentoring and validation of required systems and… more
- Prime Therapeutics (Columbia, SC)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… 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 ... promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- Fresenius Medical Center (Columbia, SC)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Molina Healthcare (Cayce, SC)
- …are seeking a (RN) Registered Nurse with previous experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge of ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Sedgwick (Columbia, SC)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… more
- ManpowerGroup (Columbia, SC)
- …Education:** Bachelor's degree- Nursing. Preferred Work Experience: 7 years-healthcare program management , utilization review , or clinical experience in ... our Fortune 500 clients. **Note:-** + Must Have Behavioral Health Experience + Previous Utilization Management (UM) or Case Management (CM) experience +… more
- Highmark Health (Columbia, SC)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Defense Health Agency (Sumter, SC)
- …population-based healthassessments in order to identify strategies for effective resource utilization , disease management ,case management , and preventive ... programs, to include aeromedical waiver casesthat are submitted for higher headquarter review . Advises and educates medical and dental staff ontreatment for flying… more
