- 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
- Kepro (SC)
- …our growing team. Job Summary: The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements ... to determine medical appropriateness. Job Responsibilities: + Assures accuracy and timeliness...Responsibilities: + Assures accuracy and timeliness of all applicable review type cases within contract requirements. + Assesses, evaluates,… 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)
- …Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical bills from providers including complex ... and RNE review ; two (2) years of experience with complex medical , legal and consult review ; and two (2) years of experience in daily application of nurse… more
- Humana (Columbia, SC)
- …and help us put health first** The Group Medicare Proposal Development/Contract Review Professional 2 reviews solicitations and prepares routine contract review ... (RFPs)/request for renewals (RFRs). The Group Medicare Proposal Development/Contract Review Professional 2 is primarily responsible for reviewing moderate to… 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
- Evolent Health (Columbia, SC)
- …decisions against criteria and policy, escalating questions to the physician reviewer , and creating letters that meet regulatory and Plain Language requirements. ... team to ensure adverse determinations are measured against appropriate criteria and medical policies. + Ensure appropriate Letter templates are used. + Maintain… more
- Molina Healthcare (Charleston, SC)
- …a (RN) Registered Nurse with previous experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Terracon (North Charleston, SC)
- …of plans and specifications, observation and inspection, and the writing, preparation, and review of related reports for the services provided. Review drawings ... and recommend changes. Research and resolve design and construction problems. Assign, review , and evaluate laboratory or field data for inclusion in reports. Apply… more
- Jacobs (Greenville, SC)
- …bidding and construction and will be our discipline lead or Quality Control reviewer in project meetings. You will participate in project proposals and will suggest ... Your security. Your future. Eligible employees and their dependents may elect medical , dental, vision, and basic life insurance. Employees are able to enroll… more
- National Park Service (Ninety Six, SC)
- …Six National Historic Site in Ninety Six, SC. All basic services including schools, medical and shopping facilities are located within a short drive of the park. ... Experience should be clearly described and documented in your resume. The qualifications reviewer will not assume performance of such duties by Job Titles alone.… more
- Lowe's (Lexington, SC)
- …reviews. The Delivery Coordinator plays a critical role as gatekeeper and final reviewer of every delivery to ensure our drivers have the necessary information to ... gender, age, ancestry, national origin, mental or physical disability or medical condition, sexual orientation, gender identity or expression, marital status,… more
- GE Vernova (Greenville, SC)
- …(DRs) related to your assigned components. + Participate as a presenter or reviewer in technical and/or program reviews. + Recommend approaches to meet technical and ... continued on-the-job **learning and development** . **Healthcare benefit** **s** include medical , dental, vision, and prescription drug coverage; access to a Health… more
- KPMG (Greenville, SC)
- …tax credit services + Provide R&D tax credit quality assurance, engagement reviewer and exam support + Perform engagement management activities including billing ... are based on eligibility. Our Total Rewards package includes a variety of medical and dental plans, vision coverage, disability and life insurance, 401(k) plans, and… more
- Evolent Health (Columbia, SC)
- …1+ years of Utilization Review Experience R + Graduate of an accredited medical school. Either MD or DO degree is required. + Active physician license without ... for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director- Physical Health, you will be a key member of the utilization management… 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