- 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 ... review experience, and licenses necessary to help support members _?_ The Utilization Review Case Manager RN will provide timely, evidence-based … 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 ... determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals,… more
- Healthfirst (SC)
- …across a variety of treatment settings for high risk, complex populations + Certified Case Manager + Interqual, Milliman, and/or TruCare knowledge + Knowledge of ... preauthorization of outpatient or inpatient services + Knowledge of utilization management/quality management case philosophies and reporting requirements… more
- HCA Healthcare (Charleston, SC)
- …years of experience in Case Management is highly preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience ... satisfaction and personal growth, we encourage you to apply for our RN Case Manager opening. We promptly review all applications. Highly qualified candidates… more
- HCA Healthcare (Myrtle Beach, SC)
- …in Case Management or Critical Care is preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience ... satisfaction and personal growth, we encourage you to apply for our RN Case Manager PRN opening. We review all applications. Qualified candidates will be… more
- HCA Healthcare (Myrtle Beach, SC)
- …in Case Management or Critical Care is preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience ... to join an organization that invests in you as a **Registered Nurse (RN) Case Manager ** ? At **Grand Strand Medical Center** , you come first. HCA Healthcare has… more
- CenterWell (North Charleston, SC)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... community and help us put health first** The Clinical Manager , Home Health Nursing enables patients to stay in...clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the… more
- Highmark Health (Columbia, SC)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective ** utilization management** strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case … more
- AmeriHealth Caritas (Charleston, SC)
- …Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Care Manager II is responsible for managing and coordinating care, services, ... gaps in care and barriers to care. The Care Manager II develops a plan of care through shared...and evaluation of the effectiveness of the plan.; 2. Review medication list and educate Members with pharmacy needs,… 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 ... determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals,… more