- 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
- Humana (Columbia, SC)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… more
- Humana (Columbia, SC)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- CVS Health (Columbia, SC)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… 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...Review interdepartmental requests and medical information to complete utilization process * Documents process used and decision int… more
- Sharecare (Columbia, SC)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… 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 ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Fresenius Medical Center (West Columbia, SC)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Datavant (Columbia, SC)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
- CenterWell (Columbia, SC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff documentation… more
- AmeriHealth Caritas (Columbia, SC)
- …plan of care, referrals, and evaluation of the effectiveness of the plan + Review medication list and educate Members with pharmacy needs, and counsel on side ... ACFC electronic care management platforms where applicable + Monitor appropriate utilization and coordinate services with other payer sources, make appropriate… more