- US Tech Solutions (Columbia, SC)
- …decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. **Responsibilities:** + ... 80% May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a… more
- Evolent (Columbia, SC)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful impact… more
- Evolent (Columbia, SC)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... culture. **What You'll Be Doing:** As a Physician Clinical Reviewer , Interventional Pain Management, you will be a key...reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Evolent (Columbia, SC)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of...Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet… more
- Evolent (Columbia, SC)
- …+ Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key member of...Will Be Doing:** + Serve as the specialty match reviewer in Vascular cases, that do not initially meet… more
- Evolent (Columbia, SC)
- …**What You'll Be Doing:** What You Will Be Doing: + Serve as the Physician match reviewer in Medical Oncology and imaging cases, that do not initially meet the ... and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Columbia, SC)
- …and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... the culture. **What You'll Be Doing:** As a Field Medical Director, Oncology, you will be a key member...Will Be Doing:** . Serve as the Physician match reviewer in Advanced Imaging cases, that do not initially… more
- Terracon (Columbia, SC)
- …of plans and specifications, observation and inspection, and the writing, preparation, and review of related reports for the services provided. Review drawings ... and recommend changes. Research and resolve design and construction problems. Assign, review , and evaluate laboratory or field data for inclusion in reports. Apply… more
- Humana (Columbia, SC)
- …our caring community and help us put health first** The Supervisor, Claims Review makes appropriate claim decision based on strong knowledge of claims procedures, ... contract provisions, and state and federal legislation. The Supervisor, Claims Review works within thorough, prescribed guidelines and procedures; uses independent… more
- Humana (Columbia, SC)
- …Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, ... resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to ensure capture of… more
- Terracon (Columbia, SC)
- …Matter Expert on projects in preparation of becoming an Authorized Project Reviewer . + Begin documented mentoring and application process for Terracon Authorized ... Project Reviewer certification. + Performs other duties as assigned. **Requirements:**...role and job status, we offer many programs including medical , dental, vision, life insurance, 401(k) plan, paid time… more
- Terracon (Columbia, SC)
- …of plans and specifications, observation and inspection, and the writing, preparation, and review of related reports for the services provided. Review drawings ... and recommend changes. Research and resolve design and construction problems. Assign, review , and evaluate laboratory or field data for inclusion in reports. Apply… more
- Highmark Health (Columbia, SC)
- …and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal ... authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests.… more
- Army National Guard Units (Columbia, SC)
- …Management (RPAM); Selected Reserve Incentive Program (SRIP); Montgomery GI Bill; MOS Medical Review Board (MMRB); Line of Duty (LOD) investigations; and ... National Guard. The purpose of this position is to serve as the final reviewer and procedural authority of personnel actions submitted to the MILPO by lower… more
- Terracon (Columbia, SC)
- …operations of a department including staff training, development, and performance review , utilization of equipment and facilities, safety oversight, quality of ... or licensure in field of expertise. + Terracon Authorized Project Reviewer status preferred. \#LI-HL1 **Exemption:** Exempt **Requisition ID:** 33934BR **Posting… more
- Sumitomo Pharma (Columbia, SC)
- …analysis plans; provide additional expertise in the + undefined + undefined + Review Data Management Plan, Data Transfer Plan, Data Validation Plan and Edit Check ... + Create CDISC SDTM and ADaM files, SAS export files, Define.xml and Reviewer 's + undefined + Perform Data analysis, statistical analysis, generate safety and… more
- Otsuka America Pharmaceutical Inc. (Columbia, SC)
- …teams + Utilize platforms like Veeva Vault, to manage content lifecycle and Medical Review submissions. + Track and report content usage and effectiveness, ... regional and affiliate medical teams. + Serve as a champion for Medical Review / Promotional review processes for materials + Manage content lifecycle… more
- Travelers Insurance Company (Columbia, SC)
- …influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State ... regulations and medical guidelines to establish medical review policies. Works in close collaboration with the Claim leaders and in partnership with other … more
- Parexel (Columbia, SC)
- …PV workflows and projects and participate in safety processing for studies including medical review of serious adverse events. * Support regulatory safety ... and interactions such as: --Consultancy on protocol development, drug development program etc. -- Medical review of various documents which might be audited by… more
- Humana (Columbia, SC)
- …management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present ... to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review ...The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more