Utilization Management Registered Nurse
Humana —South Carolina
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Clinical Documentation Integrity Specialist I, Full-Time, Days
Prisma Health —Columbia, SC
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
MDS Coordinator (RN) / Health and Rehab Center / Full Time
WESLEY COMMONS —Greenwood, SC
- From $38 an hour
- Full-time
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
Nurse - MDS Coordinator
Ashley River Healthcare —Charleston, SC
- $75,000 - $88,000 a year
- Full-time
- Nursing
- Anatomy knowledge
- RN License
- Health insurance
- Dental insurance
Quick Apply
2d
RN MDS Coordinator
Brookview Healthcare Center —Gaffney, SC
- Full-time
- Background check
- Nursing
- Skilled nursing facility
- Paid holidays
- Health insurance
Quick Apply
Medical Reviewer II - Palmetto GBA
BlueCross BlueShield of South Carolina —South Carolina
- 8 hour shift
- Remote
- Background check
- Nursing
- RN License
- Health insurance
- Dental insurance
7d
Clinical Documentation Specialist
Singing River Health System —South Carolina
- Weekends as needed
- Remote
- Nursing
- Microsoft Outlook
- RN License
Quick Apply
RN Appeals Analyst (Must Reside in SC)
BlueCross BlueShield of South Carolina —South Carolina
- Full-time
- Remote
- Nursing
- RN License
- Customer service
- Health insurance
- Dental insurance
4d
Utilization Review Specialist RN PRN
Lexington Medical Center —West Columbia, SC
- PRN
- Nursing
- RN License
- Bachelor of Science
- 403(b) matching
- Disability insurance
Senior Medical Reviewer (Behavioral Health Focused)
BlueCross BlueShield of South Carolina —South Carolina
- Full-time
- Remote
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
Provider Audit Specialist - LPN or RN
BlueCross BlueShield of South Carolina —Columbia, SC
- 8 hour shift
- Hybrid work
- Nursing
- Anatomy knowledge
- Microsoft Excel
- Health insurance
- Dental insurance
Utilization Documentation Specialist, Resource Pool
Self Regional Healthcare —Greenwood, SC
- Part-time
- Nursing
- RN License
- Mid-level
Quick Apply
CDI Specialist RN
Lexington Medical Center —West Columbia, SC
- Full-time
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Disability insurance
Registered Nurse - Medical Review & Coding Specialist :: CPC/CCS
Software Technology Inc —Columbia, SC
- Nursing
- Anatomy knowledge
- RN License
Quick Apply
Utilization Specialist
Rebound Behavioral Health —Lancaster, SC
- PRN
- CPR Certification
- Nursing
- RN License
Clin Doc Integrity Spec II, Full-Time, Days
Prisma Health —Columbia, SC
- Full-time
- Nursing
- Medicine
- RN License
MDS COORDINATOR Full Time
South Carolina Baptist Ministries For The Aging In —Darlington, SC
- Full-time
- Skilled nursing facility
- RN License
- HIPAA
Quick Apply
Patient Assessment Coordinator | Aiken Rehab
PAM Health, LLC —Aiken, SC
- Full-time
- CPR Certification
- Nursing
- RN License
- Health savings account
- Disability insurance
Quick Apply
3d
Registered Nurse - MDS Coordinator
PruittHealth —Columbia, SC
- Full-time
- Background check
- RN License
- Mid-level
- Paid orientation
- Referral program
2d
MDS Nurse, Part-time
Patewood Post Acute —Greenville, SC
- $35 - $45 an hour
- Part-time
- Skilled nursing facility
- Mid-level
- Rehabilitation center
Quick Apply

I want to receive the latest job alert for clinical documentation & utilization review nurses in south carolina

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

clinical documentation & utilization review nurses jobs near south carolina

Clinical Documentation Specialist jobs in South Carolina

Registered Nurse jobs in South Carolina

Mds Coordinator jobs in Columbia, SC

Patient Coordinator jobs in Aiken, SC

Registered Nurse jobs in West Columbia, SC

Nurse jobs in Greenville, SC

Licensed Practical Nurse jobs in Columbia, SC

Nurse jobs in Charleston, SC

Clinical Documentation Improvement Specialist jobs in Columbia, SC

Behavioral Specialist jobs in South Carolina

Clinical Research Nurse jobs in New Orleans, LA

Non Clinical Occupational Therapist jobs in Massachusetts

Clinical Documentation Specialist jobs in Atlanta, GA

Clinical Documentation Specialist jobs in North Carolina

Clinical Documentation Specialist jobs in Long Beach, CA

Clinical Documentation Specialist jobs in Wellington, FL

Senior Clinical Nurse jobs in Atlanta, GA

Senior Clinical Nurse jobs in Chandler, AZ

Senior Software Engineer jobs in Pittsburgh, PA

Senior Clinical Nurse jobs in New York, NY

Utilization Management Registered Nurse

Humana -
South Carolina

Apply Now

Job Details

Full-time
$71,100 - $97,800 a year

Benefits

Paid parental leave
Caregiver leave
Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Work from home
Parental leave
Vision insurance
Life insurance

Qualifications

RN License
Nurse Licensure Compact (NLC)

Full Job Description

Become a part of our caring community

The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting.

As a Utilization Management Registered Nurse:

You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers
You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?)

You will communicate with providers, members, or other parties to facilitate care and treatment.
You will help deliver coordinated care for our members
You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.

Use your skills to make an impact

Required Qualifications:

Must hold Compact Registered Nurse (RN) license in your state of residence
Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
Must be passionate about contributing to an organization focused on improving consumer experiences

Preferred Qualifications:

Previous experience in utilization management/utilization review for a health plan or acute care setting
Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
Experience working in a fully remote, metrics-focused role
Experience as an MDS Coordinator or discharge planner in an acute care setting
Experience as an RN for a Medicare Certified Home Health agency
Health Plan or Medicare / Medicaid Experience
Call center or triage experience
BSN or bachelor's degree in a related field

Additional Information

Work-at-Home Information:

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Apply Now

Refine Your Search

clinical documentation & utilization review nurses jobs in south carolina

Utilization Management Registered Nurse

Clinical Documentation Integrity Specialist I, Full-Time, Days

MDS Coordinator (RN) / Health and Rehab Center / Full Time

Nurse - MDS Coordinator

RN MDS Coordinator

Medical Reviewer II - Palmetto GBA

Clinical Documentation Specialist

RN Appeals Analyst (Must Reside in SC)

Utilization Review Specialist RN PRN

Senior Medical Reviewer (Behavioral Health Focused)

Provider Audit Specialist - LPN or RN

Utilization Documentation Specialist, Resource Pool

CDI Specialist RN

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

Utilization Specialist

Clin Doc Integrity Spec II, Full-Time, Days

MDS COORDINATOR Full Time

Patient Assessment Coordinator | Aiken Rehab

Registered Nurse - MDS Coordinator

MDS Nurse, Part-time

I want to receive the latest job alert for clinical documentation & utilization review nurses in south carolina

Explore jobs in more locations

Become a part of our caring community

Use your skills to make an impact

Required Qualifications:

Preferred Qualifications:

Additional Information

Work-at-Home Information:

About us

Job Seeker Tools

Employer Tools

Browse

Stay Connected