- 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
- Lincoln Financial Group (Columbia, SC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Evolent Health (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
- Evolent Health (Columbia, SC)
- …Stay for the culture. **What You'll Be Doing:** As a Pain Management Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… 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 ... working. Remote position after initial onsite Equipment will be provided. Registered Nurse with > 5 years nursing experience. Background in med/surg, previous case… 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 ... and increase member program engagement. 20% Performs medical or behavioral review /authorization process. + Ensures coverage for appropriate services within benefit… more
- ManpowerGroup (Columbia, SC)
- …of medical claims review processes, medical necessity guidelines, and utilization review practices. + Proficiency in medical terminology, coding procedures, ... and medical necessity of services. + Ensure thorough documentation of each determination for utilization or claims review . + Review first-level appeals and… more
- ManpowerGroup (Columbia, SC)
- …to join one of our Fortune 500 clients. **Job Summary** The Medical Review and Utilization Management Specialist is responsible for performing medical reviews ... using established criteria and conducting utilization management of professional, inpatient, outpatient, or facility benefits/services, as well as appeals. This role… 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