- Humana (Columbia, SC)
- …for utilization management and clinical decision-making as outlined in the Autism Care Demonstration (ACD) defined in the TRICARE Operations Manual Chapter 18, ... UM tools to assist in guiding clinical decisions, reviewing for appropriate care and setting, following guidelines and policies, and approve services or forward… more
- Highmark Health (Columbia, SC)
- …:** Highmark Inc. **Job Description :** **JOB SUMMARY** This job provides telephonic integrated behavioral and physical health case and condition management ... with mental health, substance use, and co-morbid chronic medical conditions. Behavioral health conditions include serious mental illness, untreated mental health,… more
- Highmark Health (Columbia, SC)
- …as the single point of contact for members to coordinate all of the member's care needs across the various service delivery systems and community supports. This is a ... to complete face to face needs assessments with subsequent telephonic contact with the member in accordance with state...and protocols. + Assess, plan, coordinate, implement and evaluate care for eligible members with chronic and complex health… more
- US Tech Solutions (Columbia, SC)
- …Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of Care Referrals, etc.). ... **Job Description:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise,… more