- Sharecare (Columbia, SC)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and objectives of the… more
- US Tech Solutions (Columbia, SC)
- …have critical thinking skills. + Experience in case management or care coordination and telephonic care experience is preferred. + A typical day would be managing a ... to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk pregnancy or… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- US Tech Solutions (Columbia, SC)
- …of service or due date to determine the priority of our cases. Then we review the requests against the policy and the member's contract. When reviewing the clinical ... level. If not, then it would be sent for review with our medical director. We would then complete...with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more