- 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
- Evolent (Columbia, SC)
- …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake … more
- Veterans Affairs, Veterans Health Administration (Columbia, SC)
- Summary The Registered Nurse (RN) Clinical Documentation Integrity Nurse Advisor provides care and counseling of persons or in the promotion and maintenance of ... health teaching, health counseling. Responsibilities The Clinical Documentation Integrity Registered Nurse Advisor (CDI RNA) understands a wide range of specialized… more
- Humana (Columbia, SC)
- …for review depending on case findings. Educates providers on utilization and medical management processes. + Enters and maintains pertinent clinical information ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care...Utilization Management (UM), Pre-Auth, and/or other managed care review experience + 1 or more years of acute… 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
- 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
- Highmark Health (Columbia, SC)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, 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
- 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
- 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 ... and Prevention (CDC) guidelines and recommendations.5. Completes hospital medical record review , including history of present illness and past medical history, the… more