Top 24 Utilization management Jobs in Camden, Sc

Program Coordinator II (Quality Review Specialist) / 60020122
State of South Carolina —Richland County, SC
- $52,100 - $54,000 a year
- Online Application
- Microsoft Excel
- Customer service
- Mid-level
- Paid holidays
- Disability insurance
9d
Audits Manager I (Reimbursements Manager - NHs AND FQHCs) / 60016587RP
State of South Carolina —Richland County, SC
- $66,400 - $119,500 a year
- Overtime
- Research
- Mid-level
- Office
- Paid holidays
- Disability insurance
Utilization Management Pharmacist
BlueCross BlueShield of South Carolina —Columbia, SC
- 8 hour shift
- Hybrid work
- Mid-level
- Office
- 3 years
- Health insurance
- Dental insurance
Part Time - Pharmacist - Contract 1099
Pharmacy Synergistics Inc —Camden, SC
- $52 an hour
- Full-time
- Mid-level
- Bachelor's degree
- 2 years
Quick Apply
2d
Pharmacist - Per Diem
Ernest Health —Elgin, SC
- Per diem
- Hospital
- Word processing
- Computer literacy
Nurse Practitioner
Lexington Medical Center —Columbia, SC
- Full-time
- CPR Certification
- Nursing
- RN License
- 403(b) matching
- Disability insurance
Licensed Clinical Director/LPHA
Behavioral Health Agency —Columbia, SC
- From $55,000 a year
- Full-time
- Background check
- LMFT
- Doctoral degree
- Health insurance
- Dental insurance
Quick Apply
Charge Registered Nurse - RN
Fresenius Medical Care —Sumter, SC
- Full-time
- CPR Certification
- Nursing
- RN License
10d
Grad Pharmacist
CVS Health —Sumter, SC
- $19.75 - $42.00 an hour
- Part-time
- Microsoft Excel
- Microsoft Outlook
- Patient monitoring
- Dental insurance
- Vision insurance
Physician ED Claims Reviewer
Vytwo —United States
- Full-time
- Remote
- Mid-level
- 2 years
Quick Apply
Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply

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Audits Manager I (Reimbursements Manager - NHs AND FQHCs) / 60016587RP
State of South Carolina —Richland County, SC
A bachelor's degree in accounting, business administration, finance, insurance, or a related field and experience in professional level accounting, auditing, or…
$66,400 - $119,500 a year

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Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Quick Apply
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Conducts utilization reviews of behavioral health cases to determine medical necessity…

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utilization management jobs near camden, sc

Program Coordinator II (Quality Review Specialist) / 60020122

State of South Carolina -
Richland County, SC

Apply Now

Job Details

Full-time
$52,100 - $54,000 a year
9 days ago

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Vision insurance
Flexible schedule
Life insurance
Prescription drug insurance

Qualifications

Driver's License

Full Job Description

Job Responsibilities

The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians.

This is position is located in Bureau of Provider & Support Services, Richland County.
This is an in-office role and not a telecommute or remote position.

Are you the One? We are looking for a Program Coordinator II (Quality Review Specialist) who supports the successful delivery of quality control and audit functions for claims processing within the Bureau of Provider and Support Services. Works under general direction reporting to the Director of Support Services. Identifies and responds to claims related audits, external reviews, and internal quality control functions for claims processing for Fee For Service and Waiver beneficiaries specifically for Long Term Care (LTC), Hospice and Nursing Home Claims. Has sound general, domain and specific knowledge of claims processing and demonstrates application of this knowledge. Applies methodical approach(es) to issue definition and resolution. Demonstrates effective communication skills. Demonstrates excellent customer service. Plans, schedules, and monitors own work within deadlines according to management.

Develops Bureau-wide quality control plan and dashboard to include production and quality metrics for staff completing claims and provider services functions. Fosters a Bureau-wide commitment to quality assurance. Performs data collection, data analysis methodology, and implements performance improvement methods. Leads performance improvement projects and provide education and coaching in order to build needed skills in others. Coordinates with directors/managers to ensure continuous improvement efforts are integrated into all offices and sections, including staff responsibilities.
Serves as the Bureau Lead for all audits (including internal, single state, PERM, etc.). Collaborate with stakeholders both within and outside of the Bureau to ensure all audit requests are completed timely and meet all requirements. Upon completion of audit, work with Bureau Directors to address any deficiencies and create corrective action plans to regain compliance.
Serves as Bureau Lead for performing quality control audits of claims and provider services staff utilizing a combination of system reports and random sampling. Perform trend analysis for any repeat errors and collaborate with Bureau Director for remedial training of staff.
Prepares reports and presents to management and external stakeholders related to processes, measures and outcomes, advising management of findings and recommendations. Leads organization toward a culture of continuous improvement.
Manages special projects as directed by the Bureau Chief of Provider Services and Support related to the development and improvement of services within the Medicaid health care delivery system.
Attends and participates in relevant opportunities for professional development and training. Demonstrates utilization and application of new skills learned to improve effectiveness and efficiency within assigned responsibilities.

The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:

Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
13 paid holidays.
State Retirement Plan and Deferred Compensation Programs.

Minimum and Additional Requirements

A bachelor's degree and one (1) year of relevant program experience.

An equivalent combination of education and experience may be accepted with prior State Human Resources approval.

Additional Requirements:

Valid driver's license.
Occasional overnight travel.
Sitting or standing for long periods of time.
Lifting requirement: 20 lbs.
In-office role.

Preferred Qualifications

Ability to work independently; to organize and complete work assignments based on level of priority and importance and take appropriate action with minimal guidance.
Ability to maintain a positive working environment with internal and external relationships.
Capable of following oral and written policies/regulations.
Must be able to maintain a strict level of confidentiality.
Advanced skills with applications such as Microsoft Word and Excel.
Knowledge of laws, regulations, policies and procedures relevant to the claims processing and related services for Hospice, LTC and Nursing Homes.
Ability to exercise judgment and discretion.
Ability to establish and maintain effective working relationships.
Ability to interpret and apply laws, regulations, policies and procedures.
Ability to communicate effectively.

Additional Comments

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

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utilization management jobs in camden, sc

Program Coordinator II (Quality Review Specialist) / 60020122

Audits Manager I (Reimbursements Manager - NHs AND FQHCs) / 60016587RP

Utilization Management Pharmacist

Part Time - Pharmacist - Contract 1099

Pharmacist - Per Diem

Nurse Practitioner

Licensed Clinical Director/LPHA

Charge Registered Nurse - RN

Grad Pharmacist

Physician ED Claims Reviewer

Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)

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