- 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 (North Charleston, 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
- Roper St. Francis (Charleston, SC)
- …asrelated to drug selection, restriction, and medication protocol development and review . + Participates in the development of initiatives related to successfully ... Goals + Promote and demonstrate rational, cost effective drug therapy. + Review select patients' medication therapy for accuracy and appropriateness. + Identify and… more
- First Horizon Bank (SC)
- …or relocation will be provided for this role.** **SUMMARY** The Commercial Credit Review Officer, Sr (Sr CRO) is responsible for evaluating portfolio quality and ... strategy, and risk appetite. The Sr CRO typically reports to a Credit Review Manager and is expected to operate independently, following Credit Assurance Services… 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
- Truist (Greenville, SC)
- …English (Required) **Work Shift:** 1st shift (United States of America) **Please review the following job description:** This role will be remote within the ... Truist footprint. Motivate and lead a collateral review team to ensure pipeline metrics and quality goals...the division of Truist offering the position. Truist offers medical , dental, vision, life insurance, disability, accidental death and… 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
- Terracon (Ridgeland, SC)
- …documented mentoring and application process for Terracon Authorized Project Reviewer certification. **Requirements:** + Bachelor's degree in technical discipline ... type of services and projects being managed + Authorized Project Reviewer status preferred. **Exemption:** Exempt **Requisition ID:** 31690BR **Posting Title:**… 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
- Terracon (North Charleston, 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