- CVS Health (Columbia, SC)
- …Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate ... of Care: * Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and… more
- CVS Health (Columbia, SC)
- …Interviewing and good technological skills + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations ... standard business hours. No weekends and no holidays.** Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical… more
- Molina Healthcare (Darlington, SC)
- **JOB DESCRIPTION** Case Manager will work in remote and field setting supporting our Medicaid SMI (Severe Mental Illness) Population in the state of South ... Carolina. Case Manager will be required to communicate...per regulated timelines and determines who may qualify for case management based on clinical judgment, changes… more
- Highmark Health (Columbia, SC)
- …Nursing **EXPERIENCE** **Required** + 7 years of any combination of clinical , case management and/or disease/condition management experience, provider operations ... panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of...interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are… more
- Molina Healthcare (Columbia, SC)
- … Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education and Promotion (CHEP), ... South Carolina. Member Health Assessor will be partnering with Behavioral Health Case Managers and meeting with...+ Typically works with members with moderate to complex clinical needs. + Conducts standardized Health Risk Appraisals (HRA)… more
- CVS Health (Columbia, SC)
- …we do it all with heart, each and every day. **Job Summary** The Care Manager -Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible ... for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH)… more
- Highmark Health (Columbia, SC)
- …resource utilization, identification of opportunities for referral to a Health Coach/ case management, and identification and resolution of quality issues. Monitors ... with established industry and corporate standards and are within the care manager 's professional discipline. + Function in accordance with applicable state, federal… more
- AmeriHealth Caritas (Columbia, SC)
- **Role Overview** The Care Manager (RN) assists members appropriate for care management and care coordination services in achieving their optimal level of health ... through self-management. The Care Manager (RN) is responsible for engaging the member, member...determinants of health and supportive needs + Coordinates physical, behavioral health and social services + Provides medication management,… more
- US Tech Solutions (Columbia, SC)
- …Work Experience: 7 years-healthcare program management. Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty ... determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals,… more
- US Tech Solutions (Columbia, SC)
- …determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, ... needs of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying … more
- US Tech Solutions (Columbia, SC)
- …determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, ... of Microsoft software skills **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying… more
- US Tech Solutions (Columbia, SC)
- …+ Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of Care Referrals, ... We work with the concurrent nurses as well as case management. We also work very closely with our...as well. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria… more
- InGenesis (Columbia, SC)
- …determinations. * Identify and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, ... this role you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria...medical or behavioral eligibility regarding benefits and clinical criteria and assess and monitor medical necessity using… more
- CenterWell (Columbia, SC)
- …Intelligence Lead and support ad hoc reporting. * Develop basic modeling and business case analysis; work closely with Finance and Data teams * Coordinate with ACO ... that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time… more
- Highmark Health (Columbia, SC)
- …Is responsible for or works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs in the facilities to identify ... related to special projects and providing coverage for coding manager (s). (10%) + Depending on location provides or arranges...processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and… more