NewRegistered Nurse (RN)-Hospital Case Manager, Full-Time, Days Prisma HealthRegistered Nurse (RN)-Hospital Case Manager, Full-Time, DaysColumbia, SCThe Hospital Case Manager (HCM) provides case management service for hospital patients, including, but not limited to, utilization management to ensure efficient, cost-effective patient progression through the continuum of care and discharge to an appropriate level of care. 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.
Social Worker, Hospital Case Management, Full Time, Days Prisma HealthSocial Worker, Hospital Case Management, Full Time, DaysColumbia, SCCurrently licensed as a Licensed Master Social Worker (LMSW) by the state Board of Social Work Examiners or currently licensed as a Licensed Independent Social Worker (LISW) by the state Board of Social Work Examiners. Intervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs.
Case Management Coordinator CVS Health CorpCase Management CoordinatorSC$21.10–$40.90 / hourAs a member of the care team, you will collaborate with members, the internal care team, healthcare providers, and community organizations to meet the complex healthcare and social needs of our members Be part of this exciting opportunity as we expand our DSNP services to transform lives in new markets across the country. As a vital member of our Special Needs Plan (SNP) care team, the Care Coordinator (CC) is responsible for coordinating care for our members through close collaboration with the Care Manager, Social Worker, and other interdisciplinary team members.
Registered Nurse Case Manager - Case Management McLeod HealthRegistered Nurse Case Manager - Case ManagementSCCommunicates 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.
Case Manager/PT - Case Management McLeod HealthCase Manager/PT - Case ManagementSCCommunicates 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.
NewNursing Case Manager (Full-Time) - Case Management McLeod HealthNursing Case Manager (Full-Time) - Case ManagementSCCommunicates 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.
NewCase Management Coordinator Paladin Consulting, Inc.Case Management CoordinatorColumbia, SC$30 / hourProvides 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.
Case Management Specialist CVS Health CorpCase Management SpecialistSC$21.10–$36.78 / hourAs an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health.
Director-Clinical- Case Management -RN MUSCDirector-Clinical- Case Management -RNColumbia, South CarolinaCurrent American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification is required If you like working with energetic enthusiastic individuals, you will enjoy your career with us! Collaborates with leaders to establish operating procedures, enhance clinical and non-clinical workflows, increase productivity, and improve overall quality outcomes and operational efficiencies within a variety of delivery settings.
Director-Clinical- Case Management -RN Medical University of South CarolinaDirector-Clinical- Case Management -RNColumbia, South CarolinaCurrent American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification is required If you like working with energetic enthusiastic individuals, you will enjoy your career with us! Collaborates with leaders to establish operating procedures, enhance clinical and non-clinical workflows, increase productivity, and improve overall quality outcomes and operational efficiencies within a variety of delivery settings.
Case Manager - Utilization Management McLeod HealthCase Manager - Utilization ManagementSouth Carolina, SCCommunicates 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.
Social Worker Case Manager - (13250) InGenesisSocial Worker Case Manager - (13250)Columbia, SCRemoteAs 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.
Medical Case Manager-HIV, Infectious Disease, FT, Days Prisma HealthMedical Case Manager-HIV, Infectious Disease, FT, DaysColumbia, South CarolinaProvides outpatient HIV medical case management services and patient advocacy through education, counseling, advocacy, benefits assessment and enrollment, and coordination of services. Provides services to people living with HIV/AIDS who are medically managed through the grant-funded Ryan White Program – Division of Infectious Diseases.
NewNurse Case Manager (RN) Your Health OrganizationNurse Case Manager (RN)Cayce, SCScheduling Management and Oversight: Responsible for managing and overseeing the scheduling process completed by case managers to ensure providers and other disciplines have a well-structured and effective schedule. •Team Leadership: Lead and manage a care team consisting of healthcare professionals, including but not limited to nurses, social workers, therapists, and health coaches.
Therapist Case Manager University Health Services IncTherapist Case ManagerWEST COLUMBIA, SCOperating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. Responsibilities Three Rivers Midlands is seeking a dynamic & talented Full-time Therapist/Case Manager Three Rivers Midlands is a comprehensive behavioral health facility treating children and adolescents through residential and Rehabilitative Behavioral Health Services (RBH).
EAP Case Manager, Senior - Substance Abuse Professional (SAP) Full-time (Remote U.S., Preferred in GA, MD, NC, SC, VA) Acentra HealthEAP Case Manager, Senior - Substance Abuse Professional (SAP) Full-time (Remote U.S., Preferred in GA, MD, NC, SC, VA)SCRemote$67,600–$90,000 / yearJob Summary: As an EAP Case Manager, Senior - Substance Abuse Professional (SAP), this role provides expert management and clinical consultation to support a comprehensive Employee Assistance Program (EAP), delivering guidance on complex workplace and behavioral health issues. The position serves as a clinical resource to EAP Consultants, Onsite Clinicians, EAP Affiliates, Human Resources and organizational leadership through consultation, organizational support, care coordination, and regulatory‑aware clinical decision‑making.
High Value Case Manager Morgan & Morgan, P.A.High Value Case ManagerColumbia, SCThis employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. As a High Value Case Manager, you must be highly organized and able to work on a varied caseload, take pride in what you do, you will assist the attorney in developing settlements, preparing documents and correspondence as needed.
Case Manager Morgan & Morgan, P.A.Case ManagerColumbia, SCThis employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. From attorneys in all 50 states, to client support staff, creative marketing to operations teams, every member of our firm has a key role to play in the winning fight for consumer rights.
Medical Case Manager - Team Lead, Infectious Disease, FT, Days Prisma HealthMedical Case Manager - Team Lead, Infectious Disease, FT, DaysColumbia, South CarolinaResponsible for the provision and evaluation of services delivered by assigned Medical Case Managers for delivery of competent, quality patient care and support services for assigned areas. Serves as Team Leader, coordinating the work of a group of assigned staff in the day-to-day operations of the team.
Case Manager- Columbia State of South CarolinaCase Manager- ColumbiaColumbia, SC$40,000–$42,000 / yearJOB SUMMARY: Under general supervision they will be responsible for the preparation of child support cases for Family court; performance of activities in the courtroom under the supervision of DSS attorneys; the follow-up on these cases, including parent locate and processing of interstate cases; and is responsible for providing general child support services to clients as required or needed. JOB DUTIES: 30% - COMMUNICATIONS & CORRESPONDENCE Communication with other units within the Office of Integrated Child Support Services and other components within the Department of Social Services; adds support order data to IVD system, as well as financial information to ensure distribution of collections.
Hospice RN Nurse Case Manager Your Health OrganizationHospice RN Nurse Case ManagerLexington, SCWe 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. The Nurse Case Manager will be required to travel to patients’ homes, long-term care facilities, etc. to evaluate patients and initiate telemedicine visits.
Case Manager, Registered Nurse CVS Health CorpCase Manager, Registered NurseSC$60,522–$129,615 / yearAssesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
EAP Case Worker, Senior - Substance Abuse Professional (SAP) Full-time (Remote U.S., Preferred in GA, MD, NC, SC, VA) Acentra HealthEAP Case Worker, Senior - Substance Abuse Professional (SAP) Full-time (Remote U.S., Preferred in GA, MD, NC, SC, VA)SCRemote$67,600–$80,000 / yearJob Summary: As an EAP Case Manager, Senior - Substance Abuse Professional (SAP), this role provides expert management and clinical consultation to support a comprehensive Employee Assistance Program (EAP), delivering guidance on complex workplace and behavioral health issues. The position serves as a clinical resource to EAP Consultants, Onsite Clinicians, EAP Affiliates, Human Resources and organizational leadership through consultation, organizational support, care coordination, and regulatory‑aware clinical decision‑making.
Case Worker, Behavioral Care, PRN, Days Prisma HealthCase Worker, Behavioral Care, PRN, DaysColumbia, SCCoordinates care and educates physicians and other staff to facilitate the effective use of clinical and financial resources, focusing on admission, concurrent/continued stay and discharge planning needs in an effort to obtain acute care certification for the patient. Serves as a resource to physicians, social workers and other staff for quality and utilization issues in the acute care environment as well as discharge planning needs.
Remote Registered Nurse (RN) Case Manager ValerisRemote Registered Nurse (RN) Case ManagerColumbia, South CarolinaRemoteBacked by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. calling and working with the patient’s insurance payer to determine coverage benefits, anticipated out-of-pocket costs associated with their therapy and resources for financial assistance, where applicable based upon needs communicated by the patient.
Case Manager Encompass Health Rehabilitation Hospital of ColumbiaCase ManagerColumbia, SCJoin Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on each patient's journey. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, among other accolades, which is nothing short of amazing.
Telephonic Case Manager I - Columbia, SC CorVel CorpTelephonic Case Manager I - Columbia, SCColumbia, SCRemote$63,739–$95,264 / yearPay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained within 3 years of hire if no nationally recognized certification is present at time of hire.
Medical Case Manager II CorVel CorpMedical Case Manager IIColumbia, SCRemote$66,941–$101,258 / yearIn addition, Medical Case Managers are eligible for bonus and will be provided state-of-the-art technological devices to ensure ready access to CorVel's proprietary Case Management application, enabling staff to retrieve documents on the go and log activities as they occur. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.
Telephonic Case Manager I - Columbia, SC CorVel Healthcare CorporationTelephonic Case Manager I - Columbia, SCColumbia, SCRemote$63,739–$95,264 / yearPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained within 3 years of hire if no nationally recognized certification is present at time of hire.
Enrollment Intake Specialist | Case Mgmt MMC GroupEnrollment Intake Specialist | Case MgmtColumbia, SCAlternate Search Titles - WIOA Case Manager, Workforce Eligibility Specialist, WIOA Enrollment Specialist, Workforce Development Specialist, WIOA Compliance Coordinator, Career Services Eligibility Specialist, WIOA Certification Specialist. Throughout the past 35+ years, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries.
Nurse Case Manager - Home IV Palmetto Infusion Services LLCNurse Case Manager - Home IVWest Columbia, SCEssential Functions: Provides infusion and other skilled nursing care to patients including, but not limited to: Patient assessment and reassessment; Patient and caregiver education/teaching; Development and revision of the Plan of Care and the Plan of Treatment; Implementation of physician orders; Monitoring patient response; Response to emergency patient needs; Psychosocial support. About the Role: The Nurse Case Manager - Home Infusion (Nurse Case Manager - Home IV) coordinates patient care needs between the home infusion pharmacy, home health agency, hospital, physician office, and managed care providers for patients in the home setting.
Insurance Case Manager Palmetto Infusion Services LLCInsurance Case ManagerColumbia, SCFor our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities. policies and/or FDA guidelines providing the initial clinical review; Documents in the EMR system the clinical rationale supporting the approval or denial of an infusion service based on the payer policy or FDA guidelines.
Case Manager - Registered Nurse - Southeast Region CVS Health CorpCase Manager - Registered Nurse - Southeast RegionSC$60,522–$129,615 / yearAssesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
Case Manager - Registered Nurse CVS Health CorpCase Manager - Registered NurseSC$60,522–$129,615 / yearAssesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
Insurance Case Manager - Home IV Palmetto Infusion Services LLCInsurance Case Manager - Home IVColumbia, SCFor our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities. We strive for more than personal service - always delivering a warm and attentive health care experience that boosts patients' state-of-mind, improves their health, and quality of life.
RN Case Manager BONUS Crescent HospiceRN Case Manager BONUSColumbia, South Carolina$70,000–$80,000 / yearFull timeAt Crescent Hospice, we look for dedicated professionals who share our belief that true hospice care extends beyond medical needs—it’s about bringing dignity, peace, and human connection to every life we touch. Nurturing Direct Care: As an RN Case Manager, you're not just coordinating care – you're a source of comfort and support for patients, ensuring their comfort and quality of life remain paramount.
Nurse Case Manager - Home IV Palmetto Infusion CareersNurse Case Manager - Home IVWest Columbia, South CarolinaProvides infusion and other skilled nursing care to patients including, but not limited to: Patient assessment and reassessment; Patient and caregiver education/teaching; Development and revision of the Plan of Care and the Plan of Treatment; Implementation of physician orders; Monitoring patient response; Response to emergency patient needs; Psychosocial support. The Nurse Case Manager – Home Infusion (Nurse Case Manager – Home IV) coordinates patient care needs between the home infusion pharmacy, home health agency, hospital, physician office, and managed care providers for patients in the home setting.
Insurance Case Manager Palmetto Infusion CareersInsurance Case ManagerColumbia, South CarolinaFor our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities. policies and/or FDA guidelines providing the initial clinical review; Documents in the EMR system the clinical rationale supporting the approval or denial of an infusion service based on the payer policy or FDA guidelines.
Nurse Case Manager - Home IV Palmetto Infusion Services, LLCNurse Case Manager - Home IVWest Columbia, SCPart timeProvides infusion and other skilled nursing care to patients including, but not limited to: Patient assessment and reassessment; Patient and caregiver education/teaching; Development and revision of the Plan of Care and the Plan of Treatment; Implementation of physician orders; Monitoring patient response; Response to emergency patient needs; Psychosocial support. The Nurse Case Manager – Home Infusion (Nurse Case Manager – Home IV) coordinates patient care needs between the home infusion pharmacy, home health agency, hospital, physician office, and managed care providers for patients in the home setting.
RN Case Manager Hospice $15k Sign-on Bonus Amedisys IncRN Case Manager Hospice $15k Sign-on BonusWest Columbia, SC$80,000–$85,000 / yearAs a Hospice RN Case Manager with Amedisys-one of the nation's most respected leaders in hospice care-you'll provide comfort, dignity, and deeply personal support to patients and families during life's most meaningful moments. Develops, prepares, and maintains individualized patient care progress records with accuracy, timeliness and according to care center policies.
RN Case Manager Hospice - Orangeburg, SC Amedisys, Inc.RN Case Manager Hospice - Orangeburg, SCWest Columbia, South Carolina$80,000–$85,000 / yearFull timeAs a Hospice RN Case Manager with Amedisys—one of the nation’s most respected leaders in hospice care—you’ll provide comfort, dignity, and deeply personal support to patients and families during life’s most meaningful moments. Develops, prepares, and maintains individualized patient care progress records with accuracy, timeliness and according to care center policies.
Care Management Coordinator CVS Health CorpCare Management CoordinatorSC$21.10–$40.90 / hourAs a member of the care team, you will collaborate with members, the internal care team, healthcare providers, and community organizations to meet the complex healthcare and social needs of our members Be part of this exciting opportunity as we expand our DSNP services to transform lives in new markets across the country. As a vital member of our Special Needs Plan (SNP) care team, the Care Coordinator (CC) is responsible for coordinating care for our members through close collaboration with the Care Manager, Social Worker, and other interdisciplinary team members.
Medical Case Manager Crawford & CompanyMedical Case ManagerColumbia, SCFull timeLI-RG1Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases.
NewPersonal Injury Paralegal & Case Manager - Growth & Team The Thumbs Up GuysPersonal Injury Paralegal & Case Manager - Growth & TeamColumbia, SC$40,000–$60,000 / yearThe Thumbs Up Guys, a rapidly growing Personal Injury Law Firm based in Charleston, is expanding to Columbia and looking for enthusiastic candidates. Join a fast-paced team environment dedicated to assisting injured clients with their legal concerns.
NewPre-Litigation Paralegal - Case Manager The Thumbs Up GuysPre-Litigation Paralegal - Case ManagerColumbia, SC$40,000–$60,000 / yearWhy You Should Apply (at a glance) Voted one of the Best Law Firms to Work For 2023 & 2024Competitive benefitsCompany eventsCommitment to employee career growthTeam focusedWe are looking for a candidate who can become part of our ever-growing organization. If you have a competitive spirit, love working in a team environment, and believe in fighting for the little guy, then we invite you to apply today!
Executive Benefits Advanced Case Design Consultant Manulife Financial CorpExecutive Benefits Advanced Case Design ConsultantSCRemote$92,475–$160,290 / yearSupport the design and development of executive benefit solutions, including Nonqualified Deferred Compensation (NQDC), Supplemental Executive Retirement Plans (SERPs), Restricted Executive Bonus Arrangements (REBA), and split-dollar arrangements. Manulife/John Hancock offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans.
AVP - Medicaid Healthcare Management BlueCross BlueShield of South CarolinaAVP - Medicaid Healthcare ManagementColumbia, South CarolinaWe are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. Position Purpose: The AVP, Medicaid Healthcare Management provides leadership, direction, and oversight (clinical operations) in the establishment of strategic direction for physical and behavioral health Utilization Management (prior authorization, inpatient review), Case Management, and Population Health.
Registered Nurse (RN) - Utilization Management, PRN, Days Prisma HealthRegistered Nurse (RN) - Utilization Management, PRN, DaysColumbia, SCUses established clinical guidelines for initial/admission and continued stay reviews for patients within assigned unit to ensure medical necessity, appropriate level of care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan and CMS regulation. In collaboration with physicians, leads the multidisciplinary team including clinical staff and payors to ensure efficient delivery of quality, cost-effective care.
Concierge Care Manager BlueCross BlueShield of South CarolinaConcierge Care ManagerColumbia, South CarolinaRemoteRequired Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire; OR active, compact, multistate, unrestricted RN license as defined by the Nurse Licensure Compact (NLC); OR active licensure as a social worker, psychologist, or counselor in state of hire (Behavioral Health positions only). We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
Care Manager II AmeriHealth CaritasCare Manager IIColumbia, SCRemoteThe Care Manager II develops a plan of care through shared decision making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member’s health status, compliance with treatment plans and promote self-management. Responsible for managing and coordinating care, services, and social determinants of health for Members with acute, chronic, medically complex, and behavioral health conditions and other health needs.