- Highmark Health (Columbia, SC)
- **Company :** Endorsed **Job Description :** **GENERAL OVERVIEW** The Medical Director will provide qualified medical direction and consultation for care ... provide clinical leadership and guidance to the regional interdisciplinary team. The medical director collaborates clinically with the APP to insure standards… more
- Highmark Health (Columbia, SC)
- …Patient care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- Highmark Health (Columbia, SC)
- …conceptualize and design how people interact with finding and accessing virtual/physical medical and behavioral care in tight collaboration with our Experience, ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- NASCO (Columbia, SC)
- …Cross Blue Shield Medical , Dental, and Vision Plans + Telehealthcare - for Medical and Behavioral visits + Generous PTO with buy/sell options + 9 Company ... **Overview** As the Director of Cloud Operations at NASCO, you'll be...is designed to support the physical, mental, and financial health of our associates. We offer: **Physical and Mental… more
- Target (Lexington, SC)
- …and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical , vision, dental, ... skills for a career. The role of a Store Director can provide you with the:** + Knowledge of...utilizing tools and routines that model, train, and coach behavioral expectations to deliver the service standard + Demonstrate… more
- Conviva (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing ... enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
- Pearl Interactive Network (Columbia, SC)
- …similar agencies. + Proven track record of operational success within Call Center, Behavioral Health , or IT Support environments. + Expertise in establishing and ... **Pearl Interactive Network is sourcing a Project Control Director .** The **Project Control Director (PCD)**...Salary Range: $90K - $140K+ (commensurate with experience) + Medical , Dental, Vision, and Life Insurance + Paid time… more
- Evolent Health (Columbia, SC)
- …as required. + Entering data into a proprietary system generates cases for both the medical and behavioral health reviewers. These requests may be submitted ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...will serve as a point of contact for processing medical treatment requests in accordance with departmental policies, regulatory… more
- ManpowerGroup (Columbia, SC)
- …their health , chronic illness, or acute illness. **Responsibilities:** 1. ** Medical or Behavioral Review/Authorization Process (50%):** 2. Review medical ... resources to support review determinations and make necessary referrals to the Medical Director , Case Manager, Preventive Services, Subrogation, Quality of Care… more
- ManpowerGroup (Columbia, SC)
- …Fortune 500 clients. **Job Summary** The Clinical Review Specialist assesses and evaluates medical or behavioral eligibility for health benefits, ensuring ... necessity, support care management plans, and guide members toward better health outcomes. **Key Responsibilities:** ** Medical / Behavioral Review (50%):** +… 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 of ... and the right fit for the team. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by… 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 of ... the healthcare needs of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by… 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 of ... our members and support each other. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by… more
- ManpowerGroup (Columbia, SC)
- …managing their health , chronic or acute illnesses. **Key Responsibilities** + ** Medical or Behavioral Review & Authorization Process (50%)** + Perform review ... review determinations. + Identify and make referrals to appropriate staff (eg, Medical Director , Case Manager, Preventive Services, etc.). + Participate in… more