- ManpowerGroup (Columbia, SC)
- …communications regarding service requests. **You will need to have:** + Behavioral Health experience + Previous Utilization Management (UM) or Case ... detailed communications. **Typical Day:** + Process requests for authorization of behavioral health services. + Primarily provider-facing role. Meet timeliness… more
- Molina Healthcare (Cayce, SC)
- …with previous experience in Behavioral Health Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / ... **_JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW BEHAVIORAL HEALTH : REGISTERED NURSE (2...or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current… more
- CenterWell (Columbia, SC)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Highmark Health (Columbia, SC)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... information to improve individual outcomes as an adjunct to health coaching. If acting in the capacity as a...review. + Assist in the development and implementation of utilization management programs including but not limited… more
- Highmark Health (Columbia, SC)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Columbia, SC)
- …Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Columbia, SC)
- …for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is ... including verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… more
- Highmark Health (Columbia, SC)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Highmark Health (Columbia, SC)
- **Company :** Highmark Health **Job Description :** Job Description **JOB SUMMARY** This role within the marketing & experience department will be at the forefront ... includes leveraging cutting-edge customer experience platforms, implementing robust data management solutions, and optimizing marketing automation tools to drive… more
- Highmark Health (Columbia, SC)
- …resource efficiency. + Proposes ideas, designs, and solutions to lead engineers and management to further cloud service utilization and optimization. + Develops ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...of action. + Level 3 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Columbia, SC)
- …actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management , cultivates capabilities of staff, planning and coordination of work, ... in first-line resolution of complex technical problems 2. Provides Staff Management oversight * Hires, promotes, separates or makes recommendations regarding same… more
- Highmark Health (Columbia, SC)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- US Tech Solutions (Columbia, SC)
- …policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims ... Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit… more
- US Tech Solutions (Columbia, SC)
- …policies, and established clinical criteria to service requests or provides health management program interventions. + Utilizes clinical proficiency, claims ... + Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit… more
- Sharecare, Inc. (Columbia, SC)
- …of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. ... team. Facilitates communication exchange with primary managing physician and other providers, health plan, and the disease management program team. + Coordinates… more
- Prime Therapeutics (Columbia, SC)
- …unit, strategic planning and large scale business transformation and/or re-engineering project management in Behavioral Health public sector market is ... systems, and reporting integration. + Utilizes appropriate product and project management methodologies and tools. + Translates highly complex concepts in ways… more
- CenterWell (Columbia, SC)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... leader will play a critical role in ensuring optimal patient care, high quality health outcomes, and improved cost and utilization in pharmacy-related care, and… more
- Marriott (Columbia, SC)
- …States **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** Marriott has an exciting opportunity for a ... business systems (APIs, middleware tools etc.) + Understanding of environment management , release management , code versioning best practices, and deployment… more