- Humana (Columbia, SC)
- …community and help us put health first** Humana Healthy Horizons is seeking a Utilization Management Nurse who utilizes clinical nursing skills to support ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments...the State of South Carolina.** + Active unrestricted Licensed Registered Nurse ( RN ) in the… more
- CVS Health (Columbia, SC)
- …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing… more
- 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...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in an… more
- CVS Health (Columbia, SC)
- …And we do it all with heart, each and every day. Requisition Job Description Utilization Management is a 24/7 operation and work schedule may include weekends ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...**Required Qualifications** - 3+ years of experience as a Registered Nurse - Must have active current… more
- Humana (Columbia, SC)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… 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 4 years ... effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- US Tech Solutions (Columbia, SC)
- **Job Title:** ** Registered Nurse ** **Location: Columbia SC 29229** **Duration: 3+ month's Contract** **Job Description:** + Reviews and evaluates medical or ... mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management /clinical/or combination; 2 of the 4… more
- Fresenius Medical Center (Columbia, SC)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... by working with the Vice President of Quality and other organization management to ensure that organization/ASC policies and procedures are followed. + Responsible… more
- ManpowerGroup (Columbia, SC)
- ** Utilization Management Nurse / Social Worker (Contract Position)** **Location:** Remote (Must Train Onsite for 1-2 Weeks) - Must Reside Within 3 Hours of ... Format:** Microsoft Teams **Job Overview** We are seeking a ** Utilization Management Nurse or Licensed...School of Nursing. **Licenses & Certifications:** + **Active, unrestricted** RN license **OR** compact multistate RN license… more
- Highmark Health (Columbia, SC)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
- Sharecare (Columbia, SC)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations Manager (OM). All Sharecare… more
- Fresenius Medical Center (Columbia, SC)
- …under the direction of the Facility Manager, Director of Nursing and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in ... on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other organization administrative… more
- Evolent (Columbia, SC)
- …in Nursing (Must be a Registered Nurse ) + Experience as an RN in a Pain Management setting is preferred + Strong interpersonal and communication skills ... , you will be a key member of the utilization management team. We can offer you...Nurse , you will routinely interact with leadership and management staff, other CR's (Clinical Reviewers), providers, office staff… 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 plus, ... work with the concurrent nurses as well as case management . We also work very closely with our medical...with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member… more
- US Tech Solutions (Columbia, SC)
- …+ M-F 8:30 am to 5:00 pm REMOTE AFTER FIRST WEEK ONSITE. + Experience: Registered Nurse with > 5 years nursing experience. Background in med/surg, previous case ... mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management /clinical/or combination; 2 of 4 years… more
- Evolent (Columbia, SC)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- ManpowerGroup (Columbia, SC)
- …a dynamic and supportive environment. + Gain valuable experience in appeals and utilization management . + Collaborate with a knowledgeable and experienced team. ... + 2 years clinical experience plus 1 year in utilization /medical review, quality assurance, or home health. + An...quality assurance, or home health. + An active, unrestricted RN license from the United States and in the… more
- Lincoln Financial (Columbia, SC)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's… more
- Guardian Life (Columbia, SC)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- CenterWell (Columbia, SC)
- …for managing populations and coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is a hybrid with travel requirements to ... understanding and creating solutions that will lead to acute and post-acute care utilization reductions aligned with the PCO's objectives and goals. As a guideline,… more