Job Description Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated
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
Job Description SummaryThe LPN Care Team Member is responsible for conducting Chronic Care Management (CCM) outreach to patients with two or more chronic conditions. This role supports ongoing care coordination, improves patient outcomes, reduces avoidable hospitalizations
Date Posted:2026-03-16 Country: United States of America Location: OTSCH: South Carolina Home Offices Remote Location, Remote City, SC, 06032 USA Develop and implement the global sourcing strategy for Machines & Sub-Components, including gearless machines, motors, encoders,
Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well
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. Description Logistics: Logistics:
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 requests
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, utilization management,
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
Remote Prior Authorization Pharmacist Work From Home in Managed Care A confidential managed care organization is seeking a motivated Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe
OCM Team Lead eGroup Enabling Technologies is a nine-time Microsoft Partner of the Year award winner, specializing in Modern Workplace technologies that drive secure communication and collaboration in the cloud. As a fully remote organization with
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the
Information Systems Security Manager (ISSM) Active Clearance: Top Secret (TS), SCI preferred (Immediate eligibility for SCI/SAP required) Ability to work onsite at Shaw AFB, SC Minimum of five (5) years of IT experience CompTIA Security+ certification
Sr. Strategic Account Executive Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by
Day in the Life of a Manager of Operational Excellence The Manager of Operational Excellence is responsible for driving operational performance improvement across Crossroads Treatment Centers through structured, data-driven initiatives focused on growth, efficiency, and execution
Market Chief Medical Officer (CMO) At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the
Essential Duties and Responsibilities: - Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations. - Render medical necessity determinations for Medicare State East cases assigned. - Resolve all other technical issues within