- St. George Tanaq Corporation (Columbia, SC)
- …Experience and Skills** + One (1) year of Medicare appeals, medical review , clinical, healthcare regulatory interpretation/application, healthcare compliance or ... Dispute Resolution Reviewer I Fully Remote*GA Job Type Full-time Description...healthcare or related discipline Additional experience in Medicare appeals, medical review , clinical, or other related experience… more
- St. George Tanaq Corporation (Columbia, SC)
- …+ Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review , clinical, or related experience in a healthcare setting + Healthcare ... Dispute Resolution Reviewer III Fully Remote*GA Job Type Full-time Description...healthcare or related discipline. Additional experience in Medicare appeals, medical review , clinical, or other related experience… more
- ManpowerGroup (Columbia, SC)
- …to effectively communicate with members and healthcare providers. **Key Responsibilities** ✔ ** Medical Review & Utilization Management (80%)** + Perform ... medical reviews using established criteria and guidelines. + Review medical claims and determine reasonable charge payments. + Ensure authorization of … 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)
- …+ 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, MSK Surgery you will be a specialty match reviewer for Spine Surgery cases. you will be a key… 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)
- …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
- Evolent (Columbia, SC)
- …is needed or required. 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
- Zurich NA (Columbia, SC)
- …for the review of clinical services for the determination of medical necessity and appropriateness of care of our insureds' injured employees. You will ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking...+ 5 or more years of clinical experience in medical /surgical, orthopedic neurosurgical, psychiatric nursing, or rehab field +… 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
- Evolent (Columbia, SC)
- …better health outcomes. **Collaboration Opportunities:** + Works with the physician reviewer to monitor the adverse determination process and ensure notification ... decisions against criteria and policy, escalating questions to the physician reviewer , and creating letters that meet regulatory and Plain Language requirements.… more
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... healthcare needs of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying… more
- Sedgwick (Columbia, SC)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Estimate Review Specialist Sr. (Repair Solutions) **PRIMARY PURPOSE:** To review all ... + We offer a diverse and comprehensive benefits including medical , dental vision, 401K, PTO and more beginning your...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Intermountain Health (Columbia, SC)
- **Job Description:** Patient Account Associate II Credit Balance and Account Review Job Profile Summary Provides extraordinary care to our customers through ... flow issues, and escalating in a timely manner . Advanced knowledge of Medical Terminology . Payment Handling . Effective written and verbal communication . Assist… more
- Evolent (Columbia, SC)
- …and other clinicians who review the appeal, the claims department to review provider post-service claims for medical necessity, and managers for direction ... procedures while complying with timeliness guidelines. Our clinical nurse reviewer team values collaboration, continuous learning, and a customer-centric approach,… more
- Intermountain Health (Columbia, SC)
- …+ Understanding Coordination of Benefits + Understanding EOB + Understanding Medical Terminology + Payment Handling + Effective written and verbal communication ... + Computer Literacy + Time Management + HIPAA Regulations **Physical Requirements:** **Qualifications** + High School Diploma or equivalent (GED) required + One (1) years of experience in hospital or physician back-end revenue cycle (Payment Posting, Billing,… 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
- Otsuka America Pharmaceutical Inc. (Columbia, SC)
- …team in conjunction with global regulatory lead(s). + Prepare, coordinate and/or review all CMC and GMP related documents for submission to regulatory authorities ... and/or manufacturing experience is highly desirable. + As a CMC reviewer (assessor) with FDA or EMA is highly desirable. **Competencies** **Accountability… more
- Terracon (Columbia, SC)
- …type of services and projects being managed + Authorized Project Reviewer status. **Exemption:** Exempt **Requisition ID:** 30332BR **Posting Title:** Senior Project ... Based on eligibility, role and job status, we offer many programs including medical , dental, vision, life insurance, 401(k) plan, paid time off and holidays,… 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