- Highmark Health (Columbia, SC)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more
- Humana (Columbia, SC)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** ** Medicaid Insurance Product Management - Growth & Innovation** will ... caring community and help us put health first** Humana Medicaid is seeking exceptional candidates to join our ...(10% of time) This position is open to working remote within the US but prefer the qualified candidate… more
- Prime Therapeutics (Columbia, SC)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description ... Summary** Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Specialty Clinical Solutions team.… more
- Conviva (Columbia, SC)
- …of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing security architecture, ... ensure the enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in implementing security… more
- Humana (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Columbia, SC)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...+ Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate… more
- Humana (Columbia, SC)
- …a part of our caring community and help us put health first** The Director , Provider Contracting, leads and manages the provider networks for all of Humana's various ... lines of business through the NC Contracting team. The Director also initiates, analyzes, and negotiates hospital, physician, and/or other provider contracts and… more
- Cardinal Health (Columbia, SC)
- …and Medicaid , including duplicate discounts, fee-for-service versus managed care, medical versus pharmacy, and entity-owned versus contract pharmacy settings + A ... an individual contributor role that reports to the Sr. Director of Clinical Operations. Candidates can live anywhere in...they navigate HRSA 340B audits. This support typically is remote but may require travel to the client location.… more
- Prime Therapeutics (Columbia, SC)
- …we make. **Job Posting Title** Clinical Research Analyst, Senior - Remote **Job Description** The Senior Clinical Research Analyst works collaboratively within ... analytic code, data features, and data output using eligibility data, medical and pharmacy administrative claims. The individual will support pharmaceutical… more
- Public Consulting Group (Columbia, SC)
- …intersection and overlap between our Special Education/Case Management and school-based Medicaid services work within a state; regularly engage with counterparts + ... clients + Understand and continually monitor Federal, state, and local Medicaid School-Based program policies and guidance, collaborating with PCG subject matter… more
- Public Consulting Group (Columbia, SC)
- …individual will support the public safety consulting business line, and other Medicaid and Medicare related projects. This role will use knowledge of fire/emergency ... medical services (EMS) standards, practical and clinical experience, and...departments and/or EMS agencies at the chief officer or manager/ director level. Provenexperience with people management, strategic planning, risk… more
- Public Consulting Group (Columbia, SC)
- …support the delivery of health-related services by helping schools access critical Medicaid reimbursement. Client Success Partners (CSP) are key members of the ... PCG services. This position may report to either a SBS COE Client Success Director or a Client Success Lead. **Duties and Responsibilities** _Clients_ + Own and… more
- Humana (Columbia, SC)
- …Lead, Marketing Campaign Management - Tech Enablement, to join the team working remote anywhere in the US. The Tech Enablement Lead role reports directly to ... the Director , Technology, Measurement, & Optimization and owns the successful...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more