- ManpowerGroup (Columbia, SC)
- **Job Title: Medical Claims Reviewer ** **Pay Rate:23/Hr (REMOTE opportunity after training)** **Duration:3+ Months on W2** **Location:4101 Percival Road Columbia ... United States and in the state of hire. **Job Description:** As a Medical Claims Reviewer /Utilization Management Specialist, you will be responsible for… more
- Prime Therapeutics (Columbia, SC)
- …**Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the ... Initial Clinical Reviewers as needed to discuss cases and problems. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the MD… more
- Evolent Health (Columbia, SC)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... **What You'll Be Doing:** As a Oncology, Physician Clinical Reviewer you will be a key member of the...Oncology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when… more
- Evolent Health (Columbia, SC)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... culture. **What You'll Be Doing:** As a Physician Clinical Reviewer you will be a key member of the...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Prime Therapeutics (Columbia, SC)
- … (ICR) **Job Description Summary** Facilitates efforts in the development of medical pharmacy solutions programs. Supports drug utilization review (DUR) efforts ... practices, working closely with internal staff in the refinement of the medical pharmacy management solutions programs, providing consultation on pharmacy issues to… more
- US Tech Solutions (Columbia, SC)
- …Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. + May provide ... any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge… more
- Highmark Health (Columbia, SC)
- …OVERVIEW: * Receive, review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician ... review are provider and member requests, received from Medical Management & Policy (MM&P) and Member Grievance Departments. * Responsible for management of Peer… more
- J&J Family of Companies (Columbia, SC)
- Director, Regulatory Medical Writing (1 of 4) - 2406211847W **Description** Johnson & Johnson is currently seeking a Director, Regulatory Medical Writing. The ... their potential. At Johnson & Johnson, we all belong. The Director, Regulatory Medical Writing (RegMW) is a highly experienced medical writer and influential… more
- Sedgwick (Columbia, SC)
- …Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer SVP Bill Review - Careworks **PRIMARY PURPOSE OF THE ROLE:** To plan, direct, control and ... oversee functions within Bill Review -Careworks; and to maintain relationships with internal and external...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Meta (Columbia, SC)
- …tools, platforms, and/or products that drive workforce efficiency across Meta's reviewer workforce. 4. Drive product development with teams of world-class engineers ... color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender, gender identity, gender expression,… more
- Evolent Health (Columbia, SC)
- …Stay for the culture. **What You'll Be Doing:** As a Behavioral Health Field Medical Director will be a key member of the utilization management team. We can ... to jeans. **Collaboration Opportunities:** Evolent Health is looking for a Behavioral Health Medical Director to be a member of the Evolent clinical team. As a… more
- Highmark Health (Columbia, SC)
- …and improve the care of our members. **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- Humana (Columbia, SC)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Evolent Health (Columbia, SC)
- …team of Orthopedic and Spine Surgeons. **What You Will Be Doing:** + Provides medical direction to the support services review process. Responsible for the ... for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be...and makes recommendations into the types of cases to review . + Responsible to assist with all types of… more
- Merck (Columbia, SC)
- …to ensure that they thoroughly comprehend the science behind the medicine and review further unmet medical needs to bolster collaboration and further ... key role in the following activities: scientific literature search & review , development & review of medical education materials, participation in scientific… more
- Humana (Columbia, SC)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... health insurance, other healthcare providers + Utilization management experience in a medical management review organization, such as Medicare Advantage and… more
- J&J Family of Companies (Columbia, SC)
- Senior Analyst, Immunology Regulatory Medical Writing - 2306143143W **Description** At Johnson & Johnson Innovative Medicine (IM), what matters most is helping ... diseases of our time. IM Research & Development discovers and develops innovative medical solutions to address important unmet medical needs in oncology,… more
- CVS Health (Columbia, SC)
- …and individual client requested coverage determinations or appeals when appropriate. - Medical Directors will participate in inter-rater review activities and ... and individual client requested coverage determinations or appeals when appropriate. - Medical Directors will participate in inter-rater review activities and… more
- Cardinal Health (Columbia, SC)
- …regarding Medical Drug Information, including any MSL presentations and Medical /Safety Review Committees **Qualifications:** + 10+ years of experience ... they can focus on their patients. **What a Senior Medical Science Liaison contributes to Cardinal Health** : The...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Humana (Columbia, SC)
- …management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present ... clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more