- 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 ... caring community and help us put health first** The Medical Director actively uses their medical...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Columbia, SC)
- … medical management operational improvements, including those within the medical director area + Participate in call rotation + Develop collaborative ... in teams focusing on quality management , utilization management , case management , discharge planning...on size of region or line of business. The Medical Director conducts Utilization Management … more
- Humana (Columbia, SC)
- …and experience with national guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case reviews of requests received ... reports to the Lead Medical Director . **Other duties:** + Identify medical management operational improvements, including those within the medical … more
- Highmark Health (Columbia, SC)
- **Company :** Endorsed **Job Description :** **GENERAL OVERVIEW** The Medical Director will provide qualified medical direction and consultation for care ... delivery and complex case management for our community-based palliative care...leadership and guidance to the regional interdisciplinary team. The medical director collaborates clinically with the APP… 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 ... have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical… 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 ... like in this role: Employee will be providing telephonic case management for our members. + Past...and support each other. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria… 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 ... Registered Nurse with > 5 years nursing experience. Background in med/surg, previous case management experience preferred but not required. This is a telephonic… more
- Highmark Health (Columbia, SC)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan;...need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral… more
- Sanofi Group (Columbia, SC)
- **Job title** : Strategic Accounts Director - Vaccines, South East **Location:** Remote/Field **About the Job** The Strategic Accounts Director will lead a team ... awardees, and PBG's across the US. The Strategic Accounts Director will be responsible for achieving and driving sales...collaborating with HIT & Data Strategists to make the case for HIT optimizations/solutions, identifying HIT needs within the… more
- Sumitomo Pharma (Columbia, SC)
- …dynamic, highly motivated, and experienced individual for the position of **Associate Director , Strategic Sourcing - R&D and Supply Chain/TOQ.** The Associate ... Director Strategic Sourcing R&D and Supply Chain/Technical Operations &...opportunities. They must provide active category leadership and change management support that challenges traditional spending behavior, service level… more
- Trustmark (Columbia, SC)
- …experts in building partnerships with customers and with our employees. Regional Sales Director - Southern California We currently have a position open the in the ... Southern California Market for a Regional Sales Director (RSD). The Regional Sales Director (RSD) for Trustmark Voluntary Benefit Solutions division increases… more
- SitusAMC (Columbia, SC)
- …global but act local - come join our team! Job Profile Summary As the Sr Director of the Innovation team you will be at the forefront of developing cutting edge ... of industry and/or relevant experience, typically with 2+ years in a Senior Director level role or external equivalent. + Experience with the most current… more
- Verint Systems, Inc. (Columbia, SC)
- …covering the four pillars. + Responsible for all aspects of leave management , 401(k), tuition reimbursement, paid time off, annual holiday schedules and worker's ... meetings with immigration counsel to review latest legal updates, trends and case highlights/movement. + Effectively manage a team of two senior benefits analysts… 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 ... work independently, prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience… more
- ManpowerGroup (Columbia, SC)
- …resources to support review determinations and make necessary referrals to the Medical Director , Case Manager, Preventive Services, Subrogation, Quality ... health/chemical dependency, orthopaedic, general medicine/surgery), OR 4 years in utilization review/ case management /clinical roles, with at least 2 years of… more
- Gentiva (Columbia, SC)
- …the care they need with dignity, grace, and love. **As a Hospice RN/ RN Case Manager, you will:** + Reportdirectly to the Administrator, Executive Director or ... Manager Senior and will maintain primary control and professional management of each patient. + Act as primary liaison...supportive care to the patient's family with a reasonable case load while providing a trusting and compassionate relationship… more
- ManpowerGroup (Columbia, SC)
- …support review determinations. + Identify and make referrals to appropriate staff (eg, Medical Director , Case Manager, Preventive Services, etc.). + ... Working knowledge of spreadsheet and database software. + **Experience:** + Background in case management or care coordination, and telephonic care experience. +… more
- ManpowerGroup (Columbia, SC)
- …up review determinations. + Identify and refer cases to appropriate internal departments (eg, Medical Director , Case Manager, Quality of Care Referrals). + ... members receive quality, cost-effective care. The Clinical Review Specialist will review medical necessity, support care management plans, and guide members… more
- Hilton (Columbia, SC)
- …award\-winning culture\. On the Infrastructure Messaging team reporting to the Director of Infrastructure and Platform Engineering Messaging you will support ... \(SDLC\) plans\. + Contribute to test strategy and change management campaigns to support technology execution\. + Participate in...deliverables you will take ownership of:** + The use case catalog for all assigned projects and the SharePoint… more
- Public Consulting Group (Columbia, SC)
- …Understand the important points of intersection and overlap between our Special Education/ Case Management and school-based Medicaid services work within a state; ... Implement best practice models and structures for client communication and management , including coordinating involvement from other functional areas + Seek… more