- Humana (Columbia, SC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director actively uses their medical...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Columbia, SC)
- … medical management operational improvements, including those within the medical director area + Participate in call rotation + Develop collaborative ... in teams focusing on quality management , utilization management , case management , discharge planning...on size of region or line of business. The Medical Director conducts Utilization Management … more
- Humana (Columbia, SC)
- …and experience with national guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case reviews of requests received ... reports to the Lead Medical Director . **Other duties:** + Identify medical management operational improvements, including those within the medical … more
- Highmark Health (Columbia, SC)
- **Company :** Endorsed **Job Description :** **GENERAL OVERVIEW** The Medical Director will provide qualified medical direction and consultation for care ... delivery and complex case management for our community-based palliative care...leadership and guidance to the regional interdisciplinary team. The medical director collaborates clinically with the APP… more
- CVS Health (Columbia, SC)
- …will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a ... have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical… more
- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality ... like in this role: Employee will be providing telephonic case management for our members. + Past...and support each other. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria… more
- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality ... Registered Nurse with > 5 years nursing experience. Background in med/surg, previous case management experience preferred but not required. This is a telephonic… more
- Highmark Health (Columbia, SC)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan;...need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral… more
- Sanofi Group (Columbia, SC)
- **Job title** : Strategic Accounts Director - Vaccines, South East **Location:** Remote/Field **About the Job** The Strategic Accounts Director will lead a team ... awardees, and PBG's across the US. The Strategic Accounts Director will be responsible for achieving and driving sales...collaborating with HIT & Data Strategists to make the case for HIT optimizations/solutions, identifying HIT needs within the… more
- Sumitomo Pharma (Columbia, SC)
- …dynamic, highly motivated, and experienced individual for the position of **Associate Director , Strategic Sourcing - R&D and Supply Chain/TOQ.** The Associate ... Director Strategic Sourcing R&D and Supply Chain/Technical Operations &...opportunities. They must provide active category leadership and change management support that challenges traditional spending behavior, service level… more
- Trustmark (Columbia, SC)
- …experts in building partnerships with customers and with our employees. Regional Sales Director - Southern California We currently have a position open the in the ... Southern California Market for a Regional Sales Director (RSD). The Regional Sales Director (RSD) for Trustmark Voluntary Benefit Solutions division increases… more
- SitusAMC (Columbia, SC)
- …global but act local - come join our team! Job Profile Summary As the Sr Director of the Innovation team you will be at the forefront of developing cutting edge ... of industry and/or relevant experience, typically with 2+ years in a Senior Director level role or external equivalent. + Experience with the most current… more
- Verint Systems, Inc. (Columbia, SC)
- …covering the four pillars. + Responsible for all aspects of leave management , 401(k), tuition reimbursement, paid time off, annual holiday schedules and worker's ... meetings with immigration counsel to review latest legal updates, trends and case highlights/movement. + Effectively manage a team of two senior benefits analysts… more
- Sharing Hope SC (West Columbia, SC)
- …Writes orders in the medical record under the supervision of the SHSC Medical Director or transplant surgeon according to SHSC and hospital protocol. 13. ... parameters defined by the associated protocols under the guidance of the AOC and Medical Director (eg, monitor bedside and laboratory parameters, initiate donor … more
- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality ... work independently, prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience… more
- ManpowerGroup (Columbia, SC)
- …resources to support review determinations and make necessary referrals to the Medical Director , Case Manager, Preventive Services, Subrogation, Quality ... health/chemical dependency, orthopaedic, general medicine/surgery), OR 4 years in utilization review/ case management /clinical roles, with at least 2 years of… more
- Gentiva (Columbia, SC)
- …the care they need with dignity, grace, and love. **As a Hospice RN/ RN Case Manager, you will:** + Reportdirectly to the Administrator, Executive Director or ... Manager Senior and will maintain primary control and professional management of each patient. + Act as primary liaison...supportive care to the patient's family with a reasonable case load while providing a trusting and compassionate relationship… more
- ManpowerGroup (Columbia, SC)
- …support review determinations. + Identify and make referrals to appropriate staff (eg, Medical Director , Case Manager, Preventive Services, etc.). + ... Working knowledge of spreadsheet and database software. + **Experience:** + Background in case management or care coordination, and telephonic care experience. +… more
- ManpowerGroup (Columbia, SC)
- …up review determinations. + Identify and refer cases to appropriate internal departments (eg, Medical Director , Case Manager, Quality of Care Referrals). + ... members receive quality, cost-effective care. The Clinical Review Specialist will review medical necessity, support care management plans, and guide members… more
- Hilton (Columbia, SC)
- …award\-winning culture\. On the Infrastructure Messaging team reporting to the Director of Infrastructure and Platform Engineering Messaging you will support ... \(SDLC\) plans\. + Contribute to test strategy and change management campaigns to support technology execution\. + Participate in...deliverables you will take ownership of:** + The use case catalog for all assigned projects and the SharePoint… more