- 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
- 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
- Molina Healthcare (Lexington, SC)
- **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... are most receptive including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in non-clinical settings and… more
- Humana (Columbia, SC)
- …Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG or Interqual ... goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization requests for...review depending on case findings. + Educates providers on utilization and medical management processes. + Enters… 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)
- …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
- Fresenius Medical Center (Rock Hill, SC)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… 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
- 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)
- …**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
- 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 ... established clinical criteria to service requests or provides health management program interventions. . Utilizes clinical proficiency, claims knowledge/analysis,… 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
- Veterans Affairs, Veterans Health Administration (Columbia, SC)
- …Service (PM&Rs). The incumbent will work alongside a multidisciplinary team of pain management staff within the Pain Clinic Section of PM&Rs. The physician will work ... of the PM&Rs programs in the areas of: Resource Utilization Accomplishment of local, VISN and national goals. Safety...pain section chief, Chief of PM&Rs and Medical Center management . Collaborate with pain section chief, Chief of PMRs,… more
- Humana (Columbia, SC)
- …project management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals + ... following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Begins to… more
- Sharing Hope SC (West Columbia, SC)
- …Degree Travel Percentage Road Warrior Job Shift Rotating Shift Job Category Nurse Description SummaryThe Clinical Donation Coordinator I (CDC I) supports the mission ... as needed for donor work-up/evaluation. 11. Initiates, performs and oversees donor management according to SHSC guidelines. 12. Writes orders in the medical record… 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