- 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...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
- Cognizant (Columbia, SC)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals… more
- US Tech Solutions (Columbia, SC)
- …yrs. UM and/or appeals experience. + Experience with prior insurance, utilization management , case management , surgical or behavioral health experience. ... + Performs thorough research of the substance of service appeals by both member and provider based on clinical...experience or 2 years clinical experience plus 1 year utilization /medical review, quality assurance, or home health. **Skills:** +… more
- US Tech Solutions (Columbia, SC)
- …+ Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits ... or services, and appeals . Documents decisions using indicated protocol sets or clinical...guidelines. Provides support and review of medical claims and utilization practices. **Responsibilities:** + 80% May provide any of… more