- 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 ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- ManpowerGroup (Columbia, SC)
- …29229** **Duration: 3 months** **Rate range: $25 to $30** **Position Overview** The Utilization Review Nurse performs medical or behavioral eligibility ... + Active RN license. + Minimum of 2 years of hospital experience. + Utilization review experience is highly preferred. + Strong clinical expertise with… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- Humana (Columbia, SC)
- …that supports the goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization requests for appropriate care ... onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN, Intern will utilize Humana's Medicaid training and engage formerly… 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
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… 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
- Evolent (Columbia, SC)
- …be the single point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work can be divided into ... for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for utilization … 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 the 4 ... mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4… more
- ManpowerGroup (Columbia, SC)
- …Bachelor's degree- Nursing. Preferred Work Experience: 7 years-healthcare program management, utilization review , or clinical experience in defined specialty. ... quality, cost effective outcomes. *50% Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… 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 the 4 ... increase member program engagement. . 20% Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… 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 ... services meet benefit and medical necessity guidelines. 6. Utilize resources for review determinations and make referrals to appropriate staff, such as Medical… more
- United Therapeutics (Columbia, SC)
- …reimbursement support, patient support programs, field reimbursement managers, patient navigators and nurse educators + Review Needs Assessment Forms related to ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more
- Veterans Affairs, Veterans Health Administration (Columbia, SC)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Learn more. EDRP Authorized: Former EDRP participants ... in the performance of the PM&Rs programs in the areas of: Resource Utilization Accomplishment of local, VISN and national goals. Safety Participate in administrative… 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