- Organon & Co. (Columbia, SC)
- **Job Description** **The Position** The Women's Health Clinical Account Specialist (WHCAS) supports customers by providing clinical information on our Company's ... products, as well as education, and supporting clinical training programs. They do this to support customer needs, to help the provider or system meet the goals of… more
- CVS Health (Columbia, SC)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Columbia, SC)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- Humana (Columbia, SC)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Columbia, SC)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Evolent (Columbia, SC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Fresenius Medical Center (West Columbia, SC)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- Sharecare (Columbia, SC)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Columbia, SC)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Highmark Health (Columbia, SC)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- InGenesis (Columbia, SC)
- …efficiencies, we deliver strategic, data-driven solutions that include redefining workforce management and clinical service delivery. Explore InGenesis to ... InGenesis is currently seeking a Licensed Practical Nurse / LPN to work remotely with our...In this role, you will perform Medical Review of clinical information using established criteria or clinical … more
- Evolent (Columbia, SC)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- US Tech Solutions (Columbia, SC)
- … clinical criteria to service requests or provides health management program interventions. + Utilizes clinical proficiency, claims knowledge/analysis, ... prioritize effectively and have critical thinking skills. + Experience in case management or care coordination and telephonic care experience is preferred. + A… more
- CenterWell (Columbia, SC)
- …requires you to sit on-site at our Columbia, SC branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. This role is focused on both home... documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates… more
- Edwards Lifesciences (Columbia, SC)
- …post-case management , 3 Mensio management , Therapy Awareness program management and clinical education programs. + Implementing sales and educational ... and implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential… more
- Highmark Health (Columbia, SC)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including review… more
- Sharecare (Columbia, SC)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- AmeriHealth Caritas (Columbia, SC)
- …complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable + Monitor appropriate utilization and ... of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care and barriers to care.… more
