- Sharecare (Columbia, SC)
- …affordable for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals ... and cost-effective manner while ensuring high quality care. The Clinical Registered Nurse coordinates with the Primary...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Evolent (Columbia, SC)
- …and client policies and procedures while complying with timeliness guidelines. Our clinical nurse reviewer team values collaboration, continuous learning, ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management … 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 Client ... Format:** Microsoft Teams **Job Overview** We are seeking a **Utilization Management Nurse or Licensed Social Worker** to perform medical reviews and utilization… more
- Lincoln Financial (Columbia, SC)
- …looking for** * Minimum of 5 years of disability claims experience * Current Registered Nurse license or Licensure in Clinical psychology or Social Work * 4 ... a Glance** We are excited to bring on a Clinical Operations Manager to our organization. As a ...be responsible for leading and managing a team of nurse disability consultants and behavioral health consultants. This includes… more
- US Tech Solutions (Columbia, SC)
- …health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/ clinical /or combination; 2 of 4 years must ... + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and… 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 ... a pro-active education and support plan, consistent with/based on the comprehensive quarterly clinical systems review and clinical outcomes to ensure center… more
- PruittHealth (Columbia, SC)
- ** CLINICAL COMPETENCY COORDINATOR** **Join the PruittHealth family, where the health and safety of our workforce is our top priority!** We're not only committed to ... provided to patients is determined by assessing competency of clinical staff on an ongoing basis, evaluating care provided...conditions and acuity. 7. Meets regularly with DHS to review learning needs, coordinate training and to implement plans… 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 years ... + Reviews and evaluates medical or behavioural eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and… more
- InGenesis (Columbia, SC)
- InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will review ... and evaluate medical or behavioral eligibility regarding benefits and clinical criteria and assess and monitor medical necessity using your clinical proficiency… more
- InGenesis (Columbia, SC)
- …our client located in Columbia, SC. In this role, you will perform Medical Review of clinical information using established criteria or clinical guidelines. ... In this role, you will provide support and review of medical claims and utilization practices. This is a REMOTE opportunity for a LPN living in the state of South… more
- Lincoln Financial (Columbia, SC)
- …Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible ... claims. In this role you will act as a clinical resource for Group Protection benefit specialists and claim...for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state… more
- Prime Therapeutics (Columbia, SC)
- …that meet clinical review criteria. Refers all cases not meeting clinical criteria to pharmacist clinical reviewer . + Practices and maintains the ... medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when further review is necessary. + Other duties as… more
- Public Consulting Group (Columbia, SC)
- …learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager will be ... efficient, equitable, and client-centered * Handles case assignments, draft service plans, review case progress, and manages ongoing care needs * Travels within the… more
- Defense Health Agency (Columbia, SC)
- …care facilities. These affiliations provide for student instruction and supervision for clinical learning experiences and an enriched spectrum of clinical ... two seminaries and two universities. **Responsibilities** As an License Practical Nurse /Vocational Nurse you will: Obtains information from patient and/or… more
- US Tech Solutions (Columbia, SC)
- …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, must ... of training, they have a queue they work the incoming cases out of. They review the requested procedure against the criteria we use to determine if the procedure can… more
- Fresenius Medical Center (Sumter, SC)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...for other staff members. + Routinely meets with the Clinical Manager to discuss personnel and patient care status,… more
- Public Consulting Group (Columbia, SC)
- …efficient, equitable, and client-centered + Handles case assignments, draft service plans, review case progress and determine case closure + Travels within the State ... patients make informed decisions by acting as their advocate regarding their clinical status and treatment options + Develops effective working relations and… more
- Highmark Health (Columbia, SC)
- …over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and ... utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts… more
- Evolent (Columbia, SC)
- …The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the ... appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership. The Appeals teamwork strategies and opportunities for… more
- Sedgwick (Columbia, SC)
- …Candidates must live within the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on ... Fortune Best Workplaces in Financial Services & Insurance Remote Accommodations Clinical Specialist- Bilingual French, Hindi, Bengali or more **We are looking… more