- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director ...Utilization Management programs at AnMed. The Medical Director ensures the program and associated ... the leadership and staff who perform the functions of Utilization Management (UM), Case Management ...practice preferred. + Minimum of five years post residency medical practice experience with hospital, managed care or long-… more
- Humana (Columbia, SC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Columbia, SC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Columbia, SC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… 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 ... over phone. Strong reading comprehension as they will read and interpret medical policies. **Responsibilities:** + Reviews and evaluates medical or behavioral… 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 ... mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management /clinical/or combination; 2 of 4 years… more
- Select Medical (Anderson, SC)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... **Overview** **Critical Illness Recovery Hospital** ** Director of Case Management ** **_Clinical license...in social work and minimum three (3) years of medical case management or similar experience._** **Previous… more
- Molina Healthcare (Charleston, SC)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... resource management . + Develops and implements a Utilization Management program and action plan, which...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Evolent (Columbia, SC)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Evolent (Columbia, SC)
- …in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... for the culture. **What You'll Be Doing:** As a Field Medical Director , you will be a key member of the utilization management team. We can offer you a… more
- HCA Healthcare (Myrtle Beach, SC)
- …want to join an organization that invests in you as a Director Case Management ? At Grand Strand Medical Center, you come first. HCA Healthcare has committed ... our team. **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all… more
- Humana (Columbia, SC)
- …a part of our caring community and help us put health first** The Director , IT Vendor Management establishes and implements hardware and software acquisition, ... standards and procedures that are aligned with IT standards and strategy. The Director , IT Vendor Management requires an in-depth understanding of how… more
- CVS Health (Columbia, SC)
- … will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a ... System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management ) experience *Active and current state medical license in CA without… 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. The ... Corporate Medical Director works on problems of diverse scope and complexity...skills with prior experience leading teams focusing on quality management , utilization management , discharge planning… more
- Humana (Columbia, SC)
- …of Agreements, coding practices, Clinical Integration, Long Term Services & Supports, and Case Management . The Medical Director , as indicated, could need to ... caring community and help us put health first** The Medical Director 's primary responsibility is the review...skills with 5+ years of experience focusing on quality management , utilization management , discharge planning,… more
- United Therapeutics (Columbia, SC)
- …diseases, and other orphan diseases. **How you'll contribute** The Associate Global PV Case Management Director plays a key role in management and oversight ... audience and contributors + End-to-end case processing, including data entry, QC, medical review, and regulatory submissions + Project management skills and… 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 ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community… more
- HCA Healthcare (Myrtle Beach, SC)
- …Healthcare colleagues invested over 156,000 hours impacting our communities. As a Director of Physician Services II with Strand Regional Specialty Associates, you ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...vary by location._** Come join our team as a Director of Physician Services II. We care for our… more
- Stantec (Greenville, SC)
- Project Director , Owner's Representative - ( 240003LK ) **Description** We are strategizing, planning, and implementing projects that help clients achieve their ... organization's objectives. Join our award-winning program management team and bring transformational project solutions to life. By managing capital programs and… more
- HCA Healthcare (Walterboro, SC)
- …of care in 21 states and the United Kingdom. We are looking for a Director Surgical Services for our Colleton Medical Center team where excellence creates ... excellence. **Benefits** Colleton Medical Center, offers a total rewards package that supports...requests + You will be responsible for the fiscal management of department; assures proper utilization of… more