- Evolent (Columbia, SC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact ... as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to… more
- Evolent (Columbia, SC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Sharecare (Columbia, SC)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- ManpowerGroup (Columbia, SC)
- **Utilization Management Nurse / Social Worker (Contract Position)** **Location:** Remote (Must Train Onsite for 1-2 Weeks) - Must Reside Within 3 Hours of Client ... Format:** Microsoft Teams **Job Overview** We are seeking a **Utilization Management Nurse or Licensed Social Worker** to perform medical reviews and utilization… more
- Prime Therapeutics (Columbia, SC)
- …leads cross functional committees that review FWA member lock in appeals . **Responsibilities** + Leverage clinical judgement to evaluate members for potential ... years of work experience in case management or professional practice + Current Registered Nurse (RN) license in good standing with the Board of Nursing as required… more