- US Tech Solutions, Inc. (Columbia, SC)
- …PREFERRED/NICE TO HAVE skill sets/qualities: I would love to have someone with prior insurance/ utilization review experience, but I know that is not very common. ... a typical day would like in this role: The nurse would work remotely from their home reviewing authorization...any of the following in support of medical claims review and utilization review practices:… 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 4 years ... quality, cost effective outcomes. 50% Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- Lincoln Financial Group (Columbia, SC)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Sedgwick (Columbia, SC)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital...RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical bills from providers including… 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
- Prime Therapeutics (Columbia, SC)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing criteria. + At minimum ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… 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 (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)
- …Bachelor's degree- Nursing. Preferred Work Experience: 7 years-healthcare program management, utilization review , or clinical experience in defined specialty. ... Fortune 500 clients. **Note:-** + Must Have Behavioral Health Experience + Previous Utilization Management (UM) or Case Management (CM) experience + Training will be… more
- Highmark Health (Columbia, SC)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- Defense Health Agency (Sumter, SC)
- …programs, to include aeromedical waiver casesthat are submitted for higher headquarter review . Advises and educates medical and dental staff ontreatment for flying ... counsels, andoversees PCM team personnel to include physician assistants, nurse practitioners, medicaltechnicians, and administrative personnel. Provides input and… more
