58 Results for

Utilization Management Nurse Jobs in Columbia, SC

Jobs

Columbia, SC11 days ago

$31–$31 Per Hour
Employee

Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions that consist of: intensive assessment/evaluation of condition, at risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness.

Columbia, SC25 days ago

$30–$30 Per Hour
Full-time
Employee

New!

Columbia, SC2 days ago

$77,200–$106,200 Per Year

Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients.

New!

Work At Home, SC4 days ago

$29.10–$62.32 Per Hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

South Carolina15 days ago

Bachelor's degree in Nursing from an accredited school of nursing and three years’ work experience as a Registered Nurse required. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees.

South Carolina, SC26 days ago

Communicates information to the Utilization Management or Case Management team to aid in appropriate level of care determination and reimbursement by third party payors as well as working closely with Physician Advisory team on concurrent denials to ensure most appropriate level of care prior to billing. Case Manager examines records for medical treatments and interventions to avoid payment denial resulting in optimization in reimbursement by assessing appropriateness of treatments, effectiveness, timing, and setting.

Columbia, SC19 days ago

$30–$30 Per Hour

Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions thatconsist of: intensive assessment/evaluation of condition, at risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness.

columbia, SC30+ days ago

Required Certifications/Registrations/LicensesSouth Carolina Official Recognition Nurse Practitioner - NLNPPrescriptive Authority South Carolina Nursing LicenseSouth Carolina Controlled Substance license; Federal DEA licenseIn Lieu Of The Above Minimum RequirementsN/AOther Required Skills and ExperienceN/AWork ShiftVariable (United States of America)Location1850 Laurel St ColumbiaFacility3487 Weight Management 1850 LaurelDepartment34871000 Weight Management 1850 Laurel-Practice OperationsShare your talent with us! Participates in:Establishment of quality assurance programsEstablishment of utilization management programsSelection of management information systemsDevelopment of patient education servicesDevelopment of patient satisfaction surveysAssists in the development of operational and capital budgets.

Columbia, SC30+ days ago

Maintain courteous and cooperative working relationships with all levels of management and employees, physicians, patients, guarantors and the general public. Engages in the diagnosis and treatment of disease, defects or injuries and recommend or prescribe treatments for the relief or cure of physical, mental or functional ailments or defects.

Columbia, SC19 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. This credential is the highest status for nursing excellence that recognizes organizations for nursing excellence, transformational leadership, high-quality care and nursing satisfaction and empowers professional practice.

Columbia, SC30+ days ago

In Lieu Of In lieu of the BSN requirement above, a nursing diploma or an Associate degree in Nursing may be considered if the applicant signs a BSN Memorandum of Understanding (MOU) agreeing to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN degree within (4) four years of hire date. Job Summary The Hospital Care Manager (HCM) is an integral care team partner that focuses on patient engagement and activation, has primary accountability for patients care transition out of the acute care setting and positively impacts longitudinal care plan alignment.

Chapin, SC13 days ago

This position involves proficient chart preparation, communication, scheduling of patient visits, appropriate utilization and logging of chronic care management activities, and provider and patient support. We are a leading physician group serving South Carolina and Georgia, dedicated to delivering quality healthcare directly to patients in care facilities, homes, clinics, and virtual visits.

Columbia, SC19 days ago

Columbia, SC30+ days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Open to all doctors and patients, our continuum of care begins with disease prevention and management and extends to emergency services and procedures, with diagnosis, surgery, and rehabilitation, all performed in beautiful surroundings of our hospital.

New!

Columbia, SC6 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Open to all doctors and patients, our continuum of care begins with disease prevention and management and extends to emergency services and procedures, with diagnosis, surgery, and rehabilitation, all performed in beautiful surroundings of our hospital.

New!

Columbia, SC6 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Open to all doctors and patients, our continuum of care begins with disease prevention and management and extends to emergency services and procedures, with diagnosis, surgery, and rehabilitation, all performed in beautiful surroundings of our hospital.

Columbia, SC30+ days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization Communicates the patient/family's need for education/teaching to others in the healthcare continuum. Prisma Health Richland Hospital Medical Intensive Care Unit A regional academic medical center and hospital with more than 125 years of service to Columbia, Prisma Health Richland Hospital provides a wide range of primary and specialty healthcare services.

SC30+ days ago

Remote

$54,095–$155,538 Per Year

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

Columbia, SC30+ days ago

Columbia, SC19 days ago

Remote

$30–$30 Per Hour

Typical Day in the Role: A typical day consists of managing member caseloads through phone-based interactions, assessing care needs, coordinating with healthcare providers and patient representatives, documenting case activity, and supporting members throughout their care journey while collaborating with internal teams. This position serves as a key liaison among members, healthcare providers, patient representatives, and internal care teams to ensure effective care planning and case progression.

Columbia, SC19 days ago

Activities include but are not limited to staff allocation and scheduling; patient assignments; rounds; investigation/resolution of patient care issues; coordination of admissions, discharges, and transfers; ensuring appropriate transitions of care between shifts; and interdepartmental coordination. In lieu of the BSN requirement above, a nursing diploma or an Associate's Degree in Nursing may be considered if the applicant signs a Memorandum of Understanding agreeing to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN degree within four years.

Columbia, SC30+ days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC16 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC13 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC13 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC13 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC16 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC21 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC30+ days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Cayce, SC15 days ago

Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the regions third largest employer.

New!

Columbia, SC5 days ago

Remote

As the industry landscape shifts with new challenges in patient care, quality and compliance requirements, workforce retention, and operational efficiencies, we deliver strategic, data-driven solutions that include redefining workforce management and clinical service delivery. With decades of experience, InGenesis has grown into one of North America’s most trusted Healthcare Services Firms, which includes comprehensive health and workforce solutions.

Columbia, SC16 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC20 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC16 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC16 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC30+ days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Required Certifications, Registrations, Licenses Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC12 days ago

Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization. Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Columbia, SC13 days ago

$67,905–$101,857 Per Year

The fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Makes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation.

South Carolina, SC30+ days ago

Columbia, SC24 days ago

Nurses hired to NSICU will continue education specifically around the neuroscience patient population and will directly assist practitioners, while monitoring patients, during bedside procedures such as IVD placement, CVC insertion and intubations. Identifies/assesses patient/family learning needs and teaches accordingly by using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Computer resources and Micromedex utilization.

Columbia, SC30+ days ago

Identifies/assesses patient/family learning needs and teaches accordingly by: using language and terminology that the patient/family is familiar with providing examples to clarify ideas, implementing and evaluating teaching plan (encourages patient/family involvement/participation), Micromedex utilization, Computer resources. Working for the Facility Resource Pool, provides clinical direction for all aspects of patient care in an acute inpatient setting, fostering patient/family centered care.

Columbia, SC30+ days ago

Full-time

Tracks and monitors facility effective utilization of PDPM tools (including but not limited to Physician Diagnosis Verification, Admission/Discharge CSR(GG), Weekly CSR, PDPM Weekly Tracking Tool, Point Right). • Schedules and conducts resident care conferences in compliance with state and federal regulations and ensures completion of all MDS reviews prior to resident care conference.

West Columbia, SC30+ days ago

Provides diagnosis and treatment of common acute illnesses; prevention and maintenance health care to patients with stable chronic illnesses; and performs interim physical examinations for healthy patients within prescribed guidelines: Elicits appropriate present and past medical history and review of systems. Provides health education to patients about ways to improve, promote, and maintain their health status, including but not limited to providing educational information on disease/disease processes, self-care practices, and positive lifestyle choices (i.e. diabetes, safe sex, weight loss, smoking cessation, etc.).

Columbia, SC13 days ago

New!

West Columbia, SC4 days ago

Columbia, SC19 days ago

$77,200–$106,200 Per Year

SC30+ days ago

$26.01–$74.78 Per Year

Application of critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for members with disabilities and special healthcare needs. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

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Utilization Management Nurse Jobs in Columbia, SC

Hospital Registered Nurse # 26-12606 US Tech Solutions

Clinical Review Registered Nurse US Tech Solutions, Inc.

Home Health Clinical Manager CenterWell Home Health

Utilization Management Nurse Consultant CVS Health Corp

Utilization Management Behavioral Health MUSC

Case Manager - Utilization Management McLeod Health

Case Management Registered Nurse # 26-12033 US Tech Solutions, Inc.

Nurse Practitioner - Weight Management - Columbia Prisma Health

Nurse Practitioner / Physician Assistant - Surgery - Trauma - Columbia Prisma Health

Registered Nurse (RN)-Acute Care, IICU, FT, Nights Prisma Health

Registered Nurse (RN)--Hospital Care Manager, Full-Time, Days Prisma Health

Clinical Coordinator - CMA, LPN, RN Your Health Organization

Registered Nurse (RN) - Acute Care, IICU, FT, Days Prisma Health

Registered Nurse (RN) - Acute Care, Cardiovascular Stepdown/LVAD, FT, Days Prisma Health

Registered Nurse (RN) - Acute Care, Cardiovascular ICU, FT, Nights Prisma Health

Registered Nurse (RN) - Acute Care, Cardiac Telemetry, FT, Days Prisma Health

Registered Nurse (RN) - Acute Care, Medical ICU, FT, Nights Prisma Health

Case Manager, Registered Nurse - Fully Remote CVS Health Corp

Registered Nurse (RN) - Acute Care, Level 1 Emergency Trauma Center, FT, Variable Prisma Health

Case Management Coordinator- Adult Care Talent Software Services, Inc.

Assistant Nurse Manager (ANM), Emergency Department, FT, Nights Prisma Health

Registered Nurse (RN)-Acute Care, ICU, PRN, Varied Shifts Prisma Health

Registered Nurse (RN)-Acute Care, OBGYN, FT, Days Prisma Health

Registered Nurse (RN)-Acute Care, ICU, PT, Days Prisma Health

Registered Nurse (RN)-Acute Care, Intensive Care Unit, ICU, FT, Days Prisma Health

Registered Nurse (RN)-Acute Care, Child and Adolescent Psych, FT, Varied Shifts Prisma Health

Registered Nurse (RN)-Acute Care, Radiology Nursing Services, FT, Day Prisma Health

Registered Nurse (RN)-Acute Care, Post Anesthesia Care Unit, PACU, FT, Days Prisma Health

Registered Nurse (RN)-Acute Care, Emergency Department, PT, Nights Prisma Health

RN Case Manager - Occ Health located at Scout Motors Lexington Medical Center

Licensed Practical Nurse / LPN - (13233) InGenesis

Registered Nurse (RN) - Acute Care, Med Surg - Medical Telemetry, FT, Days Prisma Health

Registered Nurse (RN) - Acute Care, Med Surg - Medical Telemetry, FT, Nights Prisma Health

Registered Nurse (RN) -Acute Care, Transitional Discharge Unit, PRN, Days Prisma Health

Registered Nurse (RN) - Acute Care, Family Beginnings, FT, Nights Prisma Health

Registered Nurse (RN) Acute Care, Long Term Acute Care Unit, LTACH, FT, Nights Prisma Health

Registered Nurse (RN) - Acute Care, Peds Infants-Toddlers, FT, Nights Prisma Health

RN Home Health $7500 Sign On Bonus UnitedHealth Group Inc

Case Manager/PT - Case Management McLeod Health

Registered Nurse (RN) - Acute Care, Neurosurgical ICU, FT, Days Prisma Health

Registered Nurse (RN)-Acute Care, Facility Resource Pool, PRN, Days Prisma Health

Registered Nurse (RN) - Acute Care, Richland Facility Resource Pool, PRN, Nights Prisma Health

MDS Nurse, RN Forest Acres Post Acute

Office Nurse Practitioner - Lexington Orthopaedics and Sports Medicine Lexington Medical Center

Office Nurse Practitioner Lexington Medical Center

Nurse Practitioner Lexington Medical Center

Home Health Clinical Manager Humana Inc

Prior Authorization Clinical Reviewer CVS Health Corp

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