- Humana (Columbia, SC)
- …problem-solving skills, facilitation skills **Preferred Qualifications** + Experience with utilization review process + Experience with behavioral change, ... caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health...meet one of the following:** + Active unrestricted registered nurse license in the state of Virginia or obtain… more
- Humana (Columbia, SC)
- …our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to support ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines and… more
- US Tech Solutions (Columbia, SC)
- … practices. + May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes ... to members and their families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each… more
- InGenesis (Columbia, SC)
- …established criteria or clinical guidelines. In this role, you will provide support and review of medical claims and utilization practices. This is a REMOTE ... InGenesis is currently seeking a Licensed Practical Nurse / LPN to work remotely with our...Document decisions using established protocols. * Provide support and review of medical claims and utilization practices.… more
- US Tech Solutions (Columbia, SC)
- … practices. + May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes ... to members and their families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each… more
- US Tech Solutions (Columbia, SC)
- …Knowledge of National Committee for Quality Assurance (NCAG). Knowledge of Utilization Review Accreditation Commission (URAC). Knowledge of South Carolina ... of care issues. **Experience:** + 2 years clinical experience plus 1 year utilization /medical review , quality assurance, or home health, OR, 3 years clinical.… more
- Humana (Columbia, SC)
- …of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following ... services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and… 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 (Columbia, 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
- ManpowerGroup (Columbia, SC)
- ** Utilization Management Nurse / Social Worker (Contract Position)** **Location:** Remote (Must Train Onsite for 1-2 Weeks) - Must Reside Within 3 Hours of ... 5:00 PM **Interview Format:** Microsoft Teams **Job Overview** We are seeking a ** Utilization Management Nurse or Licensed Social Worker** to perform medical… 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
- Highmark Health (Columbia, SC)
- …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- Evolent (Columbia, SC)
- …years of direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + Cardiology and Oncology ... + Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of three… more