- 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
- Molina Healthcare (Columbia, SC)
- …daytime business hours** **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management ... REGISTERED NURSE Must be licensed for the state of...Assists in preparation for regulatory audits by performing file review and preparation. + Participates in regulatory audits as… 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
- Intermountain Health (Columbia, SC)
- …anatomy and physiology. medical training such as medical assistant, certified nurse assistant, emergency medical technician. **Job Description Summary** Assesses and ... patients and/or patient's family, caregivers, and/or legal representatives socio-economic review and screening to support coordination of care. Plans interventions… 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