- 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 4 years ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- ManpowerGroup (Columbia, SC)
- …29229** **Duration: 3 months** **Rate range: $25 to $30** **Position Overview** The Utilization Review Nurse performs medical or behavioral eligibility ... + Active RN license. + Minimum of 2 years of hospital experience. + Utilization review experience is highly preferred. + Strong clinical expertise with… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- Roper St. Francis (Charleston, SC)
- …critical thinking. Ability to run effective shift safety huddles, report safety concerns, review device utilization , report staffing concerns, and review ... following established standards and practices in accordance with the South Carolina Nurse Practice Act. Applies professional nursing theory and practice to assess,… more
- Humana (Columbia, SC)
- …that supports the goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization requests for appropriate care ... onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN, Intern will utilize Humana's Medicaid training and engage formerly… 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...Works collaboratively with clinical trials program team to include review of open trials and patient accruals. + Responsible… more
- PruittHealth (Columbia, SC)
- **JOB PURPOSE:** Senior Nurse Consultant serves as a member of the clinical and region team, to assist centers in achieving clinical excellence. She/he is ... operations and quality improvement practices for designated centers. The senior nurse consultant provides education, mentoring and validation of required systems and… more
- Fresenius Medical Center (Hilton Head Island, SC)
- **PURPOSE AND SCOPE:** The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for new ... modifications to treatment plan as indicated and notifies Team Leader, Charge Nurse , Supervisor or Physician as needed. + Assesses, collaborates, and documents… more
- Fresenius Medical Center (Fort Mill, SC)
- **PURPOSE AND SCOPE:** The professional registered nurse Home Therapies RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for ... guidance from the Educator, Preceptor or in collaboration with another Registered Nurse . + Performs ongoing, systematic collection and analysis of dialysis data for… more
- Roper St. Francis (Charleston, SC)
- …as appropriate. Participates in budget preparation for cost centers. Assures economical utilization of time, materials and resources through review of workflow ... established standards and practices in accordance with the South Carolina Nurse Practice Act (RN) and following hospital standards and professional practice.… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- AmeriHealth Caritas (Florence, SC)
- …plan of care, referrals, and evaluation of the effectiveness of the plan.; 2. Review medication list and educate Members with pharmacy needs, and counsel on side ... ACFC electronic care management platforms where applicable. 6. Monitor appropriate utilization and coordinate services with other payer sources, make appropriate… more
- Fresenius Medical Center (Mount Pleasant, SC)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- Fresenius Medical Center (Rock Hill, SC)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Molina Healthcare (Charleston, SC)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Evolent (Columbia, SC)
- …be the single point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work can be divided into ... for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for utilization … more
- CenterWell (Greenville, SC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… 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 4 ... mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4… more
- Select Medical (Anderson, SC)
- …and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan ... Recovery Hospital** **Director of Case Management** **_Clinical license as a registered nurse or respiratory therapist or master's in social work and minimum three… more