- Evolent (Columbia, SC)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Fresenius Medical Center (West Columbia, SC)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Cognizant (Columbia, SC)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- Gentiva (Columbia, SC)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Fresenius Medical Center (Columbia, SC)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...transcribes, and enters physician lab orders accurately into the Medical Information System. + Ensures appropriate preparation of lab… more
- InGenesis (Columbia, SC)
- …located in Columbia, SC. In this role you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria and assess and ... monitor medical necessity using your clinical proficiency and claims knowledge. This is a REMOTE...any questions you may have. Job Duties * Perform medical review /authorization process. * Ensure coverage for… more
- PruittHealth (Columbia, SC)
- …reviewing medical records and documentation. **KEY RESPONSIBILITIES:** 1. Coordinates clinical competency assessment and training needs of clinical staff, ... ** CLINICAL COMPETENCY COORDINATOR** **Join the PruittHealth family, where...conditions and acuity. 7. Meets regularly with DHS to review learning needs, coordinate training and to implement plans… more
- CVS Health (Columbia, SC)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- US Tech Solutions (Columbia, SC)
- …productivity goal without constant direction **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical ... regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria… more
- InGenesis (Columbia, SC)
- …remotely with our client located in Columbia, SC. In this role, you will perform Medical Review of clinical information using established criteria or ... guidelines. In this role, you will provide support and review of medical claims and utilization practices....duties as assigned. Minimum Qualifications * Current Licensed Practical Nurse / LPN license in the State of South… more
- US Tech Solutions (Columbia, SC)
- …+ Assisting with triage when needed. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by ... regarding requested services and benefit exceptions. + Ensures accurate documentation of clinical information to support and determine medical necessity criteria… more
- Surgery Care Affiliates (Columbia, SC)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- CenterWell (Columbia, SC)
- …policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by ... on-site at our Columbia, SC branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient...Utilization Review staff. Upon completion of the assessment, creates and… more
- Cardinal Health (Columbia, SC)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Columbia, SC)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- AmeriHealth Caritas (Columbia, SC)
- …This position is responsible for leading and coordinating the clinical quality review process of member concerns and medical records utilizing of care ... also include supporting the annual medical record review activities including HEDIS and, Clinical Practice...bordering states may be accepted. ; **Education/Experience:** + Registered Nurse required + 3 to 5 years Managed Care… more
- Fresenius Medical Center (Columbia, SC)
- …effective dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies procedures and training and in compliance ... last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and...activities. + Enters all treatment data into the designated clinical application accurately and in a timely manner. +… more
- Fresenius Medical Center (Columbia, SC)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine...activities. + Enters all treatment data into the designated clinical application in an accurate and timely manner. +… more
- Option Care Health (Columbia, SC)
- …patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the ... the Director's time, and the remainder of the time spent providing clinical patient care activities. **Job Description:** **Job Responsibilities** **(listed in… more
- Humana (Columbia, SC)
- …our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration...of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills,… more