- US Tech Solutions (Columbia, SC)
- …Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit ... Medicare criteria. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical… more
- Highmark Health (Columbia, SC)
- …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, and identification and resolution of quality issues. Monitors and… more
- CVS Health (Columbia, SC)
- …experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience. ... At CVS Health , we're building a world of health...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- AmeriHealth Caritas (Columbia, SC)
- …determinants of health for Members with acute, chronic, medically complex and/or behavioral health conditions and other health needs. Serves as the ... **Role Overview;** The Care Manager II is responsible for managing and coordinating...in order to collaborate with identified community, medical, and/or behavioral health teams + Maintain timely, complete,… more
- Highmark Health (Columbia, SC)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... over a specified panel of members that range in health status/severity and clinical needs; and assesses health...and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create… more
- Humana (Columbia, SC)
- …part of our caring community and help us put health first** The Care Manager , Telephonic Behavioral Health 2 , in a telephonic environment, assesses and ... for the care and wellbeing of members. The Care Manager , Telephonic Behavioral Health 2...skills to determine appropriate interventions such as care coordination, health education, connection to community resources, full utilization… more
- CenterWell (Columbia, SC)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager… more
- CenterWell (Columbia, SC)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused… more
- US Tech Solutions (Columbia, SC)
- …Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit ... health /chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must… more
- US Tech Solutions (Columbia, SC)
- …10% Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit ... would like in this role: Employee will be providing telephonic case management and utilization management for our members. The expectation is to manage a caseload of… more
- CenterWell (Columbia, SC)
- …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... Will report to the Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization ...primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager… more
- US Tech Solutions (Columbia, SC)
- …Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit ... med-surg experience **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical… more
- Sharecare (Columbia, SC)
- **Job Description:** Sharecare is the leading digital health company that helps people - no matter where they are in their health journey - unify and manage all ... their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans,… more