- Humana (Columbia, SC)
- …with business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, by ... data requires an in-depth evaluation of variable factors. As the Senior Clinical Compliance Professional, you will develop and/or evaluate compliance policies and… more
- Sumitomo Pharma (Columbia, SC)
- …seeking a dynamic, highly motivated, and experienced individual for the position of ** Associate Medical Director .** The Associate Medical Director ... products. + Conduct safety surveillance over product life cycle, reviewing clinical trial and post-marketing Individual Case Safety Reports (ICSRs), including… more
- CenterWell (Myrtle Beach, SC)
- …caring community and help us put health first** The Associate Operations Director (AOD) leads Senior Focused Primary Care clinical operations in a ... adherence to policies, and procedures, and collaborates with their clinical dyad partner to achieve optimal patient outcomes and...market or center, as determined by local leadership. The Associate Operations Director helps develop and leads… more
- Humana (Columbia, SC)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical … more
- Humana (Columbia, SC)
- …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Evolent (Columbia, SC)
- …Technician (RHIT) + Certified Hematology and Oncology Coder (CHONC) + Certified Coding Associate (CCA) + Certified Professional Coder (CPC) + Certified ... authorization and financial scope within Evolent Specialty Services. Reporting to the Director , Clinical Informatics, this role is responsible for acquiring,… more
- BayCare Health System (Charleston, SC)
- …encounters to accurately assign diagnosis and procedural codes-using ICD-10-CM and CPT-4 coding systems. + Works in conjunction with various departments for missing ... Strong utilization of medical terminology and anatomy. + Assists Manager/ Director with mentoring/training of Coder I and Coder II...of Coder I and Coder II team members and clinical practice students from various colleges. + Performs other… more
- US Tech Solutions (Columbia, SC)
- …skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy experience + A ... + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and… more
- BayCare Health System (Charleston, SC)
- …Coder II assigns diagnosis and procedural codes using ICD-10-CM, ICD-10-PCS, and CPT-4 coding systems and monitors bill hold reports. + Assists Manager/ Director ... with mentoring/training of Coder I team members and clinical practice students from various colleges. + Performs other duties as assigned. Why BayCare? Our network… more
- CenterWell (Columbia, SC)
- …active participant and lead with the care team through daily huddles. + Helps Associate Medical Director (AMD), Physician and Center Administrator in setting a ... Access Nurse Practitioner, Virtual Care (VSP/PT) applies advanced education and clinical competencies to achieve optimal patient outcomes. The Acute Access Nurse… more