- Humana (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Baylor Scott & White Health (Columbia, SC)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management /clinical/or combination; 2 of ... effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- Fresenius Medical Center (Rock Hill, SC)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Myrtle Beach, SC)
- + Level Description' Management ' Leveling Guide consists of jobs with the responsibility, accountability, and decision-making authority to develop and implement ... with implementation of policies and procedures for the clinical staff.Impact* Management of professionals and support staff. Responsible for setting objectives for… more
- CenterWell (North Charleston, SC)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- AmeriHealth Caritas (Greenville, SC)
- …Nursing;(ASN) **;** is required but BSN preferred and must hold a current and unrestricted Registered Nurse ( RN ) license in good standing in South Carolina ... complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable. 6. Monitor appropriate utilization and… more
- Highmark Health (Columbia, SC)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Columbia, SC)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- HCA Healthcare (Myrtle Beach, SC)
- **Description** **Introduction** Do you have the PRN career opportunities as a ** Registered Nurse ( RN ) Case Manager** you want with your current employer? We ... colleagues. Do you want to work PRN as a ** Registered Nurse ( RN ) Case Manager**...or Critical Care is preferred. + Certification in Case Management or Utilization Review is… more
- HCA Healthcare (Walterboro, SC)
- **Description** **Introduction** Do you have the PRN career opportunities as a ** Registered Nurse ( RN ) Case Manager** you want with your current employer? We ... colleagues. Do you want to work PRN as a ** Registered Nurse ( RN ) Case Manager**...or Critical Care is preferred. + Certification in Case Management or Utilization Review is… more
- HCA Healthcare (Walterboro, SC)
- …to charitable organizations. Apply Today! **Job Summary and Qualifications** We are seeking a Registered Nurse ( RN ) Case Manager for our hospital who will ... is highly preferred. + Must be licensed as a Registered Nurse in the state which you...or Critical Care is preferred. + Certification in Case Management or Utilization Review is… more
- Highmark Health (Columbia, SC)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Centene Corporation (Columbia, SC)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Select Medical (Anderson, SC)
- …Illness Recovery Hospital** **Director of Case Management ** **_Clinical license as a registered nurse or respiratory therapist or master's in social work and ... functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning,… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management /clinical/or combination; 2 of ... mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management /clinical/or combination; 2 of… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management /clinical/or combination; 2 of ... the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active,… more
- Humana (Columbia, SC)
- …providers or members **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in either Florida or a compact state ... us put health first** Job Description Summary The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care...+ 2 or more years of Utilization Management (UM), Pre-Auth, and/or other managed care review… more
- Guardian Life (Columbia, SC)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Tidelands Health (Myrtle Beach, SC)
- …help people live better lives through better health!** **Position Summary:** The Nurse Manager Ambulatory ( RN )- Hematology/Oncology: + Under the leadership of ... the SBU leader, the Nurse Manager Ambulatory Hematology/Oncology is responsible and accountable for the planning, organizing, directing and evaluation of clinical,… more