NewEnterprise Account Executive / Healthcare Zoom Communications IncEnterprise Account Executive / HealthcareSCRemoteWe set out to build the best collaboration platform for the enterprise, and today help people communicate better with products like Zoom Contact Center, Zoom Phone, Zoom Events, Zoom Apps, Zoom Rooms, and Zoom Webinars. As part of our award-winning workplace culture and commitment to delivering happiness, our benefits program offers a variety of perks, benefits, and options to help employees maintain their physical, mental, emotional, and financial health; support work-life balance; and contribute to their community in meaningful ways.
Director, Healthcare Services - REMOTE Molina Healthcare IncDirector, Healthcare Services - REMOTEMount Pleasant, SCRemoteRegistered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). At least 8 years of health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
(Remote or Hybrid) Outpatient Psychiatrist (Adult) | Leadership Growth Opportunity Rivia Mind - Mental Healthcare(Remote or Hybrid) Outpatient Psychiatrist (Adult) | Leadership Growth OpportunityCharleston, SCRemote$220,000–$260,000 / yearLocation Eligibility: At this time, we are only able to consider applicants whose primary residence is in one of the following states within the United States of America: Connecticut, Florida, Massachusetts, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Texas. Compensation Determination: The pay range listed reflects the minimum and maximum base salary for this role, determined through an internal compensation assessment that considers similar labor markets to our practice across the United States.
Registered Nurse (RN) Clinical Specialist - Oncology & Bone Marrow Transplant - Roper Hospital Roper St. Francis HealthcareRegistered Nurse (RN) Clinical Specialist - Oncology & Bone Marrow Transplant - Roper HospitalCharleston, SCRemoteLicensure/Certification: Currently licensed as a Registered Nurse in the state of South Carolina or holds a current compact/multi-state license as a Registered Nurse in a recognized NCSBN Compact State and is not a permanent resident of SC. Job Summary: The RN Clinical Specialist exhibits current clinical knowledge and expertise for designated patient populations and is accountable for continued competence in nursing practice and clinical outcomes in accordance with current evidenced - based practice guidelines.
RN - Pediatric Intermediate Care Unit PRN Subject Matter Expert SME Interim HealthCare IncRN - Pediatric Intermediate Care Unit PRN Subject Matter Expert SMENorth Charleston, SCRemoteWe are seeking experienced Pediatric Registered Nurses currently working in a Pediatric Intermediate Care Unit setting to participate in a PRN remote Subject Matter Expert (SME) opportunity supporting healthcare content development. Operating through 300+ offices, our commitment to medical professionals is expressed through our passion to put patients first; a culture that values and appreciates all; and our ongoing efforts to advocate for medical professionals in ways that elevate their profession and reward their sacrificial work.
Program Integrity Clinical Specialist (RN or PA Req'd) TriWest Healthcare AllianceProgram Integrity Clinical Specialist (RN or PA Req'd)Charleston, SCRemoteFull timeTechnical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews.
Director, Medical Document Optimization TriWest Healthcare AllianceDirector, Medical Document OptimizationCharleston, SCRemoteFull timeLeadership: Ability to set strategic direction and translate organizational goals into operational plans; successfully leads and develops staff across varying styles and levels; provides clear expectations, effective coaching, and timely feedback; leads through a subordinate manager and drives accountability at all levels of the department. Problem Solving / Analysis: Ability to solve complex operational and systems-related problems through systematic analysis of data, workflows, and processes; exercises sound judgment in ambiguous or high-stakes situations; identifies root causes and implements durable solutions with a realistic understanding of organizational constraints.
(RN) Remote Care Review Clinician - Utilization Review Molina Healthcare Inc(RN) Remote Care Review Clinician - Utilization ReviewSCRemoteResponsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Care Manager - Maternity AmeriHealth CaritasCare Manager - MaternityCharleston, 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.
Clinical Quality Reviewer TriWest Healthcare AllianceClinical Quality ReviewerCharleston, SCRemoteFull timeo Bachelor's in Nursing or Certified Professional in Healthcare Quality (CPHQ) o 1 or more years team lead or supervisory experience o 1 year experience in Quality Management o 1 year experience with data analysis and reporting o Experience with InterQual or similar criteria sets o General knowledge of Medicare, Veterans Administration, or other government health care programs. Technical Skills: General knowledge of Medicare, Veterans Administration, or other government health care programs; knowledge in the application of clinical criteria: InterQual, Milliman, PAS-LOS, ICD-9-CM, DSM, CPT-4, and HCPCs; Proficient with Microsoft Word and Excel.
Chief of Staff to the Chief Operating Officer TriWest Healthcare AllianceChief of Staff to the Chief Operating OfficerCharleston, SCRemoteFull timeTechnical Skills: Proficient in current trends in health care management with emphasis in customer service, network management, utilization and financial trends; collaboration skills to work with TriWest management team across multiple locations; networking skills with all levels, including subcontractors. • Works on multiple high level projects including logistical coordination, data analysis, contract management and written communications in support of various business initiatives of high visibility, applying project management tools and methodologies and leadership skills to meet or exceed deadlines.