- US Tech Solutions, Inc. (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
- Compass Health Network (Columbia, SC)
- …and recommend modifications Review all patient complaints as necessary Participate in medical staff meetings Advocate and serve as a liaison for Compass in the ... in the requirements of qualified psychiatric providers Participate with the periodic review of practice management functions Review patient satisfaction surveys… more
- Lennar Homes (Columbia, SC)
- …for the Division. Monitor and coordinate potential land acquisition opportunities.Manage initial review of all potential acquisitionsTrack all sites under review ... target regions.Development/Entitlement budgeting.Compile material needed for any hearings and review boards.Work with an attorney in preparation of LOIs, Contracts,… more
- Interim HealthCare (Columbia, SC)
- …care.What sets us apart? For starters, most of our leaders are nurses or licensed medical professionals, including our CEO. So, we know firsthand what it takes to be ... knowledge and skills.Conduct home visits to evaluate care quality and review clinical notes.Use clinical judgment to manage patient populations efficiently.Why Work… more
- 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 Cardiology, Physician Clinical Reviewer you will be a key member of the...Cardiology 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
- 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
- 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
- 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
- US Tech Solutions (Columbia, SC)
- …available resources to promote quality, cost effective outcomes. 50% Performs medical or behavioral review /authorization process. Ensures coverage for ... healthcare needs of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying… 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
- Humana (Columbia, SC)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Evolent Health (Columbia, SC)
- …team of Orthopedic and Spine Surgeons. **What You Will Be Doing:** + Provides medical direction to the support services review process. Responsible for the ... for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be...and makes recommendations into the types of cases to review . + Responsible to assist with all types of… more
- Merck (Columbia, SC)
- …to ensure that they thoroughly comprehend the science behind the medicine and review further unmet medical needs to bolster collaboration and further ... key role in the following activities: scientific literature search & review , development & review of medical education materials, participation in scientific… more
- Humana (Columbia, SC)
- …and will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Humana (Columbia, SC)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... health insurance, other healthcare providers + Utilization management experience in a medical management review organization, such as Medicare Advantage and… more
