- Sedgwick Government Solutions (Charleston, SC)
- Job Details Utilization Review Case Manager RN (Remote) 2025-1434 Charleston, SC, USA Medical Services Full Time Description ** Utilization Review ... review experience, and licenses necessary to help support members _?_ The Utilization Review Case Manager RN will provide timely, evidence-based … more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review / case management/clinical/or combination; 2 of ... determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals,… more
- Healthfirst (SC)
- …across a variety of treatment settings for high risk, complex populations + Certified Case Manager + Interqual, Milliman, and/or TruCare knowledge + Knowledge of ... preauthorization of outpatient or inpatient services + Knowledge of utilization management/quality management case philosophies and reporting requirements… more
- HCA Healthcare (Charleston, SC)
- …years of experience in Case Management is highly preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience ... satisfaction and personal growth, we encourage you to apply for our RN Case Manager opening. We promptly review all applications. Highly qualified candidates… more
- HCA Healthcare (Myrtle Beach, SC)
- …in Case Management or Critical Care is preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience ... satisfaction and personal growth, we encourage you to apply for our RN Case Manager PRN opening. We review all applications. Qualified candidates will be… more
- HCA Healthcare (Myrtle Beach, SC)
- …in Case Management or Critical Care is preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience ... to join an organization that invests in you as a **Registered Nurse (RN) Case Manager ** ? At **Grand Strand Medical Center** , you come first. HCA Healthcare has… more
- CenterWell (North Charleston, SC)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... community and help us put health first** The Clinical Manager , Home Health Nursing enables patients to stay in...clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the… more
- Highmark Health (Columbia, SC)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective ** utilization management** strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case … more
- AmeriHealth Caritas (Charleston, SC)
- …Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Care Manager II is responsible for managing and coordinating care, services, ... gaps in care and barriers to care. The Care Manager II develops a plan of care through shared...and evaluation of the effectiveness of the plan.; 2. Review medication list and educate Members with pharmacy needs,… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review / case management/clinical/or combination; 2 of ... determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals,… more
- Evolent (Columbia, SC)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...and findings with matrixed Physician Business Manager . + Provides medical direction to… more
- US Tech Solutions (Columbia, SC)
- …+ Skill sets/qualities: Must have at least 2 years hospital experience, any other utilization review experience is great, different areas of work is always a ... queue they work the incoming cases out of. They review the requested procedure against the criteria we use...Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of… more
- Sharing Hope SC (North Charleston, SC)
- …and Prevention (CDC) guidelines and recommendations. + Completes hospital medical record review , including history of present illness and past medical history, the ... resources with discretion and employs professional laterality, when possible (ie, utilization of hospital profiles, engagement with donor family and hospital staff,… more
- Roper St. Francis (Summerville, SC)
- …critical thinking. Ability to run effective shift safety huddles, report safety concerns, review device utilization , report staffing concerns, and review ... is required for the ED and as designated by specialty standards and/or clinical manager and should be obtained within 6 months of hire or designation as Charge… more
- Roper St. Francis (Charleston, SC)
- …critical thinking. Ability to run effective shift safety huddles, report safety concerns, review device utilization , report staffing concerns, and review ... is required for the ED and as designated by specialty standards and/or clinical manager and should be obtained within 6 months of hire or designation as Charge… more
- Evolent (Columbia, SC)
- …Oncology clinical Q&As for provider portal, prior authorizations, lists, regimens, scope diagnoses, case review and related activities. + Review of Carepro ... value- based care and initiatives within pathway, policy, and beyond utilization management solutions. + Introduce innovative initiatives supported with evidence and… more
- SitusAMC (Columbia, SC)
- …and colleagues in terms of clients' inquiries, model implementation issues and utilization . + Provides internal support to peers including peer report reviews and ... etc. + Such other activities as may be assigned by your manager Qualifications/ Requirements: + Bachelor's Degree in finance, economics, statistics, or mathematics… more