- Humana (Columbia, SC)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- US Tech Solutions (Columbia, SC)
- …+ Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and ... service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare… more
- US Tech Solutions (Columbia, SC)
- …+ Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and ... service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare… more
- US Tech Solutions (Columbia, SC)
- …instability. Registered nurses MUST have 4 years or more of RECENT clinical experience. + Strong communication skills required to provide telephonic case management ... + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and… more
- ManpowerGroup (Columbia, SC)
- …I" to join one of our Fortune 500 clients. **Job Summary** The Clinical Review Specialist assesses and evaluates medical or behavioral eligibility for health ... benefits, ensuring services meet clinical and administrative standards. This role requires the application...and refer cases to appropriate internal departments (eg, Medical Director , Case Manager, Quality of Care Referrals). + Participate… more
- ManpowerGroup (Columbia, SC)
- …reviewing and evaluating medical or behavioral eligibility regarding benefits and clinical criteria, applying clinical expertise, administrative policies, and ... support review determinations and make necessary referrals to the Medical Director , Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.… more