- 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 4 years ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- Evolent (Columbia, SC)
- …Stay for the culture. **What You'll Be Doing:** Job description: As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… 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 ... following established standards and practices in accordance with the South Carolina Nurse Practice Act. Applies professional nursing theory and practice to assess,… 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 ... following established standards and practices in accordance with the South Carolina Nurse Practice Act. Applies professional nursing theory and practice to assess,… 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 ... following established standards and practices in accordance with the South Carolina Nurse Practice Act. Applies professional nursing theory and practice to assess,… more
- Evolent (Columbia, SC)
- …adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- InGenesis (Columbia, SC)
- …established criteria or clinical guidelines. In this role, you will provide support and review of medical claims and utilization practices. This is a REMOTE ... InGenesis is currently seeking a Licensed Practical Nurse / LPN to work remotely with our...Document decisions using established protocols. * Provide support and review of medical claims and utilization practices.… more
- PruittHealth (Columbia, SC)
- **JOB PURPOSE:** Senior Nurse Consultant serves as a member of the clinical and region team, to assist centers in achieving clinical excellence. She/he is ... operations and quality improvement practices for designated centers. The senior nurse consultant provides education, mentoring and validation of required systems and… 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 the 4 ... **Job Title:** **Registered Nurse ** **Location: Columbia SC 29229** **Duration: 3+ month's...member program engagement. + 20% Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit… more
- Fresenius Medical Center (Fort Mill, SC)
- **PURPOSE AND SCOPE:** The professional registered nurse Home Therapies RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for ... guidance from the Educator, Preceptor or in collaboration with another Registered Nurse . + Performs ongoing, systematic collection and analysis of dialysis data for… more
- Roper St. Francis (Summerville, SC)
- …as appropriate. Participates in budget preparation for cost centers. Assures economical utilization of time, materials and resources through review of workflow ... established standards and practices in accordance with the South Carolina Nurse Practice Act (RN) and following hospital standards and professional practice.… more
- Roper St. Francis (Charleston, SC)
- …as appropriate. Participates in budget preparation for cost centers. Assures economical utilization of time, materials and resources through review of workflow ... established standards and practices in accordance with the South Carolina Nurse Practice Act (RN) and following hospital standards and professional… more
- Sharecare (Columbia, SC)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- HCA Healthcare (Myrtle Beach, SC)
- …about delivering patient-centered care?** Submit your application for Operating Room Registered Nurse position and spend more time at the bedside with the patient. ... Summary and Qualifications** We are seeking an Operating Room Nurse for our ambulatory surgery center who demonstrates the...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- Lincoln Financial (Columbia, SC)
- …Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to work here?** At ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Evolent (Columbia, SC)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Highmark Health (Columbia, SC)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… 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...with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member… more
- Bon Secours Mercy Health (Greenville, SC)
- …utilizing the nurse triage algorithms. Assists with the evaluation and review of all incoming ambulatory oncology referrals and may be asked to assist ... partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, relationship-based… more
- Fresenius Medical Center (Georgetown, SC)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more