- Humana (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...make an impact** + Active Florida license or Compact Registered Nurse Clinical license without restrictions. +… more
- Humana (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- CVS Health (Columbia, SC)
- …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing… more
- CVS Health (Columbia, SC)
- …Qualifications** + Must reside in EST zone + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required + Must have active ... current and unrestricted RN licensure in state of residence + 1+ year(s)...able to work Monday through Friday, 8:00am to 5:00pm. Utilization management is a 24/7 operation. Work… more
- Humana (Columbia, SC)
- …of our caring community and help us put health first** The Senior Compliance Nurse reviews utilization management activities and documentation to ensure ... your skills to make an impact** **Required Qualifications:** + Registered Nurse with a Bachelor's degree in...action + Minimum two, (2) years of experience in utilization management + Intermediate proficiency using Microsoft… 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 ... Format:** Microsoft Teams **Job Overview** We are seeking a ** Utilization Management Nurse or Licensed...School of Nursing. **Licenses & Certifications:** + **Active, unrestricted** RN license **OR** compact multistate RN license… more
- Fresenius Medical Center (West Columbia, SC)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Columbia, SC)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... by working with the Vice President of Quality and other organization management to ensure that organization/ASC policies and procedures are followed. + Responsible… more
- Fresenius Medical Center (Columbia, SC)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… more
- Sharecare (Columbia, SC)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations Manager (OM). All Sharecare… 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 ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CenterWell (Columbia, SC)
- …a part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure ... RN license in the state(s) in which the nurse is required to practice + Ability to be...experience a plus + Previous experience in chronic disease management , utilization management , case … more
- Highmark Health (Columbia, SC)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
- Humana (Columbia, SC)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… more
- US Tech Solutions (Columbia, SC)
- …+ M-F 8:30 am to 5:00 pm REMOTE AFTER FIRST WEEK ONSITE. + Experience: Registered Nurse with > 5 years nursing experience. Background in med/surg, previous case ... mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management /clinical/or combination; 2 of 4 years… more
- Evolent (Columbia, SC)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...and Preferred:** + Current, unrestricted state licensure as a Registered Nurse - **Required** + Associate or Bachelors… more
- Intermountain Health (Columbia, SC)
- …/Professional Nursing program. + Required Licensure/Certification: State licensure as a Registered Nurse ( RN ). Preferred Qualifications + Bachelor's ... cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care.… more
- Lincoln Financial (Columbia, SC)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's… 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 ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- US Tech Solutions (Columbia, SC)
- **Job Title:** ** Registered Nurse UM II** **Location: Columbia SC 29229** **Duration: 3+ month's Contract** **Job Description:** + Reviews and evaluates medical ... mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management /clinical/or combination; 2 of the 4… more