- Cognizant (Columbia, SC)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical … more
- Humana (Columbia, SC)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- US Tech Solutions (Columbia, SC)
- … clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis ... + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and… more
- Evolent (Columbia, SC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (West Columbia, SC)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- CenterWell (Columbia, SC)
- …a part of our caring community and help us put health first** The Nurse Practitioner, Paneled applies advanced education and clinical competencies to achieve ... optimal patient panel outcomes. The Nurse Practitioner works on problems of diverse scope and...and sustained engagement in improving health outcomes, optimizing resource utilization , and ensuring effective panel management . +… more
- CVS Health (Columbia, SC)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- InGenesis (Columbia, SC)
- …efficiencies, we deliver strategic, data-driven solutions that include redefining workforce management and clinical service delivery. Explore InGenesis to ... InGenesis is currently seeking a Licensed Practical Nurse / LPN to work remotely with our...In this role, you will perform Medical Review of clinical information using established criteria or clinical … more
- Evolent (Columbia, SC)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- US Tech Solutions (Columbia, SC)
- … clinical criteria to service requests or provides health management program interventions. **Responsibilities:** + Utilizes clinical proficiency and ... + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and… more
- CenterWell (Newberry, SC)
- …auto insurance and reliable transportation. + Two years' experience as a Registered Nurse + Home Health experience required + Management experience preferred ... a part of our caring community and help us put health first** The ** Clinical Manager** coordinates and oversees all direct care patient services provided by … more
- Sharecare (Columbia, SC)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Oracle (Columbia, SC)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- Veterans Affairs, Veterans Health Administration (Columbia, SC)
- …of patient treatment goals and develops criteria to measure therapy quality management service. The Recreation Therapist works without direct supervision but is ... administratively responsible to the Associate Nurse Executive of GEC and the Associate Director for Patient Care/Nursing Services. Provides the customer with… more
- CVS Health (Columbia, SC)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… more
- Highmark Health (Columbia, SC)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more