Regional Payor Contracting Associate Fundamental Clinical & Operational Services, LLC is searching for an experienced Regional Payor Contracting Associate to focus on MCO and payor contracting for multiple client skilled nursing facilities and Behavioral Health Hospital located in South
Become a part of our caring community The Field Care Manager Nurse 2 assesses and evaluates members needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources
Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices.
Job Description SummaryResponsible for providing quality nursing care while maintaining accountability for the coordination of patient care. EntityCarolina Family Care, Inc. (CFC) Worker TypeEmployee Worker Sub-TypeRegular Cost CenterCC005453 MHP In-Basket Team Pay Rate TypeHourly Pay GradeHealth-27 Scheduled
Work Flexibility: Field-based The Field Clinical Specialist works using independent judgement, partners with local Account Managers to increase clinical support, education resulting in increased clinical acumen. Responsibilities Educate physicians on device handling, implantation and troubleshooting techniques
Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but weve been part of the national landscape for more than seven decades, with our roots firmly
Summary We are currently hiring for an RN Behavioral Health Concierge Care Manager to join BlueCross BlueShield of South Carolina. In this role as an RN Behavioral Health Concierge Care Manager, you will provide care management
Summary We are currently hiring for an RN Appeals Analyst to join BlueCross BlueShield of South Carolina. In this role as an RN Appeals Analyst, you will research the substance of complex appeal or retrospective review
Summary We are currently hiring for a Senior Medical Reviewer to join BlueCross BlueShield of South Carolina. In this role as a Senior Medical Reviewer, you will act as Team Lead for specialty programs, medical review,
Business Analyst - Clinical Analyst & Coding Specialist Sunshine Enterprise USA is retained by our valued client to search and recruit for the following executive opening: Business Analyst - Clinical Analyst & Coding Specialist Location: Fully
RN Remote In Basket Coordinator (MUST LIVE IN CHARLESTON REGION) Responsible for providing quality nursing care while maintaining accountability for the coordination of patient care. Provides nursing care to patients using the nursing process (assessment, planning, implementation, and evaluation).
Post Discharge Patient Outreach Coordinator Inspire health. Serve with compassion. Be the difference. Responsibility for initiating phone contact with discharged patients from specified units, conducting query on patient experience and recovery, and providing needed follow up
What the Associate II, Pharmacovigilance does at Worldwide Responsible for the collection, processing, evaluation and reporting of incoming Serious Adverse Event (SAE) data according to applicable regulatory guidelines/requirements, Worldwide Standard Operating Procedures (SOPs) and project specific instructions.
Essential Duties and Responsibilities: - Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations. - Render determinations for cases assigned. - Resolve all other technical issues within reconsideration assigned. - Review cases