- Healthfirst (SC)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- Sedgwick Government Solutions (Charleston, SC)
- Job Details Utilization Review Case Manager RN (Remote) 2025-1434 Charleston, SC, USA Medical Services Full Time Description ** Utilization Review Case ... and licenses necessary to help support members _?_ The Utilization Review Case Manager RN will provide...+ Documents all utilization review outcomes in utilization review software. + Collaborates with case management… 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 4 years ... prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. +… more
- Select Medical (Anderson, SC)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with… more
- TD Bank (Lexington, SC)
- …of Business:** Human Resources **Job Description:** **Department Overview:** The Senior Manager , Financial Crime Risk Management Training leads/manages a team ... risk awareness across the organization. **Depth & Scope:** + Provides people management leadership by hiring the best talent, setting goals, developing staff,… more
- TD Bank (Greenville, SC)
- …for this role. **Line of Business:** Audit **Job Description:** The Audit Manager is accountable for overseeing the planning and execution for audits covering ... utilizing their subject matter expertise. + Acts as primary contact with management regarding audit scope, findings and status **Education & Experience:** +… more
- Amazon (Charleston, SC)
- Description Amazon Books is seeking an experienced Books Risk Management (BRM) Capacity Planning Program Manager who demonstrates exceptional ownership and ... a track record of delivering exceptional customer experiences and stakeholder management . Strong decision-making abilities in ambiguous situations and excellent risk… more
- CenterWell (North Charleston, SC)
- …a part of our caring community and help us put health first** The Clinical Manager , Home Health Nursing enables patients to stay in their homes by providing health ... and personal services; supporting patients and their families. The Clinical Manager , Home Health Nursing works within specific guidelines and procedures; applies… more
- J&J Family of Companies (Charleston, SC)
- …**Job Description:** We are searching for the best talent for an Account Manager located in Charleston, SC. **About Surgery** Fueled by innovation at the ... their journey to wellness. Learn more at https://www.jnj.com/medtech As a Field Sales Account Manager , this individual will serve as the point person for end to end… more
- Highmark Health (Columbia, SC)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective ** utilization management ** strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more