We interpreted Elgin, SC as Elgin, SC. Other options include: Elgin (Lancaster County), SC
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- CVS Health (Columbia, SC)
- …Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review / utilization management required. + 3+ years of behavioral ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… 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 ... members and their families/caregivers. + Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each determination… 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 - 1+ ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… 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
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4 ... and increase member program engagement. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- Sharecare (Columbia, SC)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- US Tech Solutions (Columbia, SC)
- …will go remote. + Must have at least 2 years hospital experience, any other utilization review experience is great, different areas of work is always a plus, ... queue they work the incoming cases out of. They review the requested procedure against the criteria we use...with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member… more
- CVS Health (Columbia, SC)
- …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... compliance driven timelines. + Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization 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
- Molina Healthcare (Columbia, SC)
- **JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who lives in South Carolina, Virginia, Tennessee, North Carolina, or Florida and must be ... Behavioral health services. Strongly prefer candidates with a background on utilization management or appeals. Excellent computer multi-tasking skills and good… more