Top 12 Utilization review nurse Jobs in Columbia, Sc

Registered Nurse RN-Hospital Case Manager
Prisma Health —Columbia, SC
- Full-time
- Acute care
- Nursing
- RN License
Registered Nurse - Medical Review & Coding Specialist :: CPC/CCS
Software Technology Inc —Columbia, SC
- Nursing
- Anatomy knowledge
- RN License
- Health insurance
Quick Apply
Utilization Review Specialist RN PRN
Lexington Medical Center —West Columbia, SC
- PRN
- Nursing
- RN License
- Bachelor of Science
- 403(b) matching
- Disability insurance
7d
Registered Nurse -Community Care Case Manager
US Veterans Health Administration —Columbia, SC
- $80,126 - $145,031 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
5d
Telephonic Case Manager I - Columbia, SC
CorVel Corporation —Columbia, SC
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Outcomes Coordinator RN - Surgery
Lexington Health —West Columbia, SC
- Full-time
- Background check
- Nursing
- Surgery
- Free parking
- Continuing education credits
Quick Apply
8d
Registered Nurse (RN)-Hospital Case Manager, Full-Time, Days
Prisma Health —Columbia, SC
- Full-time
- Acute care
- Nursing
- RN License
Outcomes Coordinator RN - Surgery
Lexington Medical Center —West Columbia, SC
- Full-time
- Acute care
- Nursing
- Surgery
- 403(b) matching
- Disability insurance
Pediatric Endocrinology APP (NP/PA)
Prisma Health —Columbia, SC
- Contract
- Nursing
- Master's degree
- Pediatrics

Other jobs to consider

Find your next job by exploring related positions.

Utilization Review Specialist RN PRN
Lexington Medical Center —West Columbia, SC
Transferring calls correctly and promptly. Attending to calls on hold in a timely manner. Issues letters of non-coverage in cases where the admission or…
7d
Telephonic Case Manager I - Columbia, SC
CorVel Corporation —Columbia, SC
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…
$63,739 - $95,264 a year
Quick Apply

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
6d
Patient Support Nurse
Valeris, Inc. —Columbus, OH
Must have active RN licensure in current state of practice. 2-3 years of nursing experience with relevant disease state experience preferred.
Quick Apply
4d

Show more jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in columbia, sc

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review nurse jobs near columbia, sc

Case Manager jobs in Columbia, SC

Pediatric Nurse Practitioner jobs in Columbia, SC

Remote Project Manager jobs in Charlotte, NC

Outcomes Manager jobs in Marlton, NJ

Outcomes Manager jobs in Chicago, IL

Outcomes Manager jobs in Remote

Store Manager jobs in Appleton, WI

Construction Project Manager jobs in Tucson, AZ

Registered Nurse Case Manager jobs in Pittsfield, MA

Registered Nurse Case Manager jobs in Chesterfield, VA

Registered Nurse jobs in Greenwood, IN

Part Time Case Manager jobs in Los Angeles, CA

Iv Nurse jobs in Jacksonville, FL

Registered Nurse Case Manager jobs in Crawfordville, FL

Registered Nurse Case Manager jobs in Victoria, TX

Coding Specialist jobs in Louisville, KY

Coding Specialist jobs in Seward, NE

Remote Medical Billing Specialist jobs in Louisiana

Medical Coding jobs in Tyler, TX

Clinical Documentation Specialist jobs in Las Vegas, NV

Registered Nurse RN-Hospital Case Manager

Prisma Health -
Columbia, SC

Apply Now

Job Details

Full-time

Qualifications

RN License
Acute care facility experience

Full Job Description

Inspire health. Serve with compassion. Be the difference.

Job Summary

The 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 collaboration with physicians, leads the multidisciplinary team including clinical staff and payors to ensure efficient delivery of quality, cost-effective care.

Essential Functions

All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
Partners with the attending providers throughout hospitalization to promote effective and efficient utilization of clinical resources, ensuring quality, cost effective care. Anticipate next steps and facilitate communication to maximize care efficiencies for the patient and family.
Identifies social determinants of health that increase the patient's risk for negative outcomes. Ensures clear documentation for the interdisciplinary care team and coordinates post-acute plans with the ambulatory care management team as appropriate. Facilitates patient access to resources and relevant services.
Addresses and resolves system problems impeding diagnostic or treatment progress. Proactively identifies, resolves and documents delays and obstacles on the patient's behalf. Drives change by identifying areas where performance improvement is needed.
Navigates value-based care with expertise and ensures longitudinal plan is patient focused and aligns with patient and caregiver goals.
On the basis of preliminary risk screening, assesses patients' and family's psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.
Maintains expert level knowledge of body systems and expected clinical outcomes for patient disease process. Maintains current knowledge of changes in state and federal regulatory requirements related to the provision of care management services in an acute care setting. Maintains care management knowledge to provide services in accordance with standards of practice as established by department and management.
Ensures medical necessity, appropriate level of care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan.
Navigates the team through complex compliance, regulatory and insurance requirements. Coordinates with third party payors on a regular basis.
Serves as a resource for patients and families with regard to their rights and responsibilities, when payment of care is denied or when care is no longer medically necessary. Includes, but not limited to, delivery of the regulatory documents as provided by CMS.
Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.
Performs other duties as assigned.

Supervisory/Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Qualifications

Education - Bachelor's degree in Nursing
Experience - Three (3) years acute care nursing experience. One (1) year acute care case management experience preferred.

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. Further, employees must demonstrate sufficient progress annually toward obtaining an accredited BSN or MSN degree to remain eligible for employment or may be terminated.
Employees in this title prior to 10/24/2021 are grandfathered into the title and are only required to have an AD N or Nursing Diploma.

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.
Accredited Case Manager (ACM) or Certified Case Manager (CCM) is preferred.

Knowledge, Skills and Abilities

Knowledge of Medical Necessity Criteria preferred.

Work Shift

Day (United States of America)

Location

Baptist

Facility

1520 Baptist Hospital

Department

15207517 Hospital Case Management

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

Apply Now

Refine Your Search

utilization review nurse jobs in columbia, sc

Registered Nurse RN-Hospital Case Manager

Registered Nurse - Medical Review & Coding Specialist :: CPC/CCS

Utilization Review Specialist RN PRN

Registered Nurse -Community Care Case Manager

Telephonic Case Manager I - Columbia, SC

Outcomes Coordinator RN - Surgery

Registered Nurse (RN)-Hospital Case Manager, Full-Time, Days

Outcomes Coordinator RN - Surgery

Pediatric Endocrinology APP (NP/PA)

Other jobs to consider

Explore jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in columbia, sc

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected