- CVS Health (Columbia, SC)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CenterWell (Columbia, SC)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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
- Cognizant (Columbia, SC)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Columbia, SC)
- …proactive and sustained engagement in improving health outcomes, optimizing resource utilization , and ensuring effective panel management . + **Focus on ... part of our caring community and help us put health first** The Nurse Practitioner, Paneled applies advanced education and clinical competencies to achieve optimal… more
- InGenesis (Columbia, SC)
- InGenesis is currently seeking a Licensed Practical Nurse / LPN to work remotely with our client located in Columbia, SC. In this role, you will perform Medical ... will provide support and review of medical claims and utilization practices. This is a REMOTE opportunity for a...operations of assigned area. * Interfaces with the medical management on a regular basis to work more complex… more
- Evolent (Columbia, SC)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… 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)
- …established clinical criteria to service requests or provides health management program interventions. **Responsibilities:** + Utilizes clinical proficiency and ... education with members and providers regarding health care delivery system, utilization on networks and benefit plans. + Serves as member advocate… more
- Fresenius Medical Center (West Columbia, 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