- Humana (Columbia, SC)
- …and executes physician, hospital, and/or other provider contracts and agreements with behavioral health providers. The Director , BH Provider Contracting ... part of our caring community and help us put health first** The Director , BH Provider Contracting...May assist with identifying and recruiting providers based on network composition and needs. Decisions are typically related to… more
- Highmark Health (Columbia, SC)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This role leads a Pharmacology & Therapeutics Committee and serves as a ... and maintains objectivity. Analyzes medication safety data, leads weekly network calls using a Just Culture approach, conducts Root...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Sevita (Columbia, SC)
- …service excellence. + Quality Improvement + Represent the state on the QI Network leadership team and participate in state staff meetings + In partnership with ... the state leadership team and QI Director , develop state-specific continuous quality improvement plans + Provide...Notification Protocol; verify implementation of those plans + Complete Network Performance Audits + Work with State leadership team… more
- ManpowerGroup (Columbia, SC)
- Experis IT ManpowerGroup has partnered with a leading ** Health Insurance company** in the **Columbia, SC (Onsite)** for a **Managed Care Coordinator 1** role to ... assist their team. This is an on-site role. **Industry: Health Insurance Company** **Title:** **Managed Care Coordinator 1** **Location: Onsite - (** **Columbia,… more
- US Tech Solutions (Columbia, SC)
- …and business needs **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical ... and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis,… more
- US Tech Solutions (Columbia, SC)
- …Utilization management experience preferred. + Prior experience working for a health insurance company and/or with Medicare population. + Flexibility, dependability- ... constant direction. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical… more
- US Tech Solutions (Columbia, SC)
- …medical policies.. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical ... and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims… more
- US Tech Solutions (Columbia, SC)
- …The Option To Work Remote. + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, ... and established clinical criteria to service requests or provides health management program interventions. **Responsibilities:** + Utilizes clinical proficiency and… more
- US Tech Solutions (Columbia, SC)
- **Job Description:** . Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, ... and established clinical criteria to service requests or provides health management program interventions. . Utilizes clinical proficiency, claims… more
- US Tech Solutions (Columbia, SC)
- …of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical ... and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis,… more
- US Tech Solutions (Columbia, SC)
- …medical policies. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical ... and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis,… more