- Centene Corporation (Columbia, SC)
- …degree and 4+ years of related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse ... including a fresh perspective on workplace flexibility. + Collaborates with utilization management team to resolve complex care member issues + Maintains… more
- Humana (Columbia, SC)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Columbia, SC)
- …put health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to ... behavioral health services and/or benefit administration determinations. The Manager, Utilization Management (Behavioral Health) applies a Person-Centered… more
- Humana (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Compliance Utilization Management Nurse 2 reviews utilization management ... rotating schedule. (about 2 holidays per year) The Compliance Utilization Management Nurse 2 ensures...make an impact** **Required Qualifications** + Active unrestricted Licensed Registered Nurse , (RN), in your state of… more
- Veterans Affairs, Veterans Health Administration (Columbia, SC)
- …external customers, and accreditation stakeholders. Meet goals through efficient, effective utilization and management of organizational and personal resources. ... on an as-needed basis until positions filled. Responsibilities This RN Quality Management Accreditation Specialist must have an attitude focused on building a… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to ... education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through… more
- US Tech Solutions (Columbia, SC)
- …+ We want to see all candidates with experience with prior insurance, utilization management , case management , surgical or behavioural health experience. ... care issues. **Experience:** + 2 years clinical experience plus 1 year utilization /medical review, quality assurance, or home health, OR 3 years clinical.… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and ... to promote quality, cost effective outcomes. + Provides active case management , assesses service needs, develops, and coordinates action plans in cooperation… more
- Fresenius Medical Center (Sumter, SC)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Bon Secours Mercy Health (Columbia, SC)
- …**Summary of Primary Function/General Purpose of Position** In the capacity of a Registered Nurse , provide and facilitate coordination of services during the ... Education Specialty/Major Nursing (BSN) **Licensing/ Certification** - Licensure/Certification Required Registered Nurse with active License in State of… more
- Humana (Columbia, SC)
- …projects. **Use your skills to make an impact** **Required Qualifications** + Licensed as a Registered Nurse in the State of Wisconsin or have a compact license. ... inpatient and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance with Humana/iCare… more
- Marriott (Columbia, SC)
- …Information** Nurse CARE Manager (CARE - Coordinated Action and Response) Registered Nurse license required **Job Number** 24069165 **Job Category** Finance ... Claims Services + Collaborate with Claims department regarding case management . + Collaborate with UNM on utilization ...informed **Education or Certification** + Must be a licensed registered nurse + Certification as an occupational… more
- Evolent Health (Columbia, SC)
- …Be Doing:** As an Initial Clinical Reviewer, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Universal Health Services (West Columbia, SC)
- …of our senior leaders. If you would like to learn more about the Registered Nurse (RN) position before applying, please contact Kieanna Robinson, HR ... in nursing. Specialty certification also preferred. Licensure/Certification: Currently licensed as a Registered Nurse in the state of South Carolina. BLS/CPI… more
- Highmark Health (Columbia, SC)
- …member is responsible for building relationships, engaging clinicians, educating on Utilization Management policies and processes, developing workflows and ... in provider setting. + 3 years of experience in utilization management /care management /QA/managed care ...diploma. **Preferred** + None **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse (RN) license in PA; additional… more
- Bon Secours Mercy Health (Columbia, SC)
- …excellence. Job Description **Summary of Primary Function** In the capacity of a Registered Nurse , the Ambulatory Care Manager will provide clinical care ... management services to identified eligible patients; coordinating care to...Bachelor's Degree Specialty/Major Nursing (BSN) **Licensing/ Certification** Licensure/Certification **Required** Registered Nurse with active License in State… more
- Centene Corporation (Columbia, SC)
- …community setting. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Registered Nurse License Compact Clinical licensure for multiple ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more