2 results for Utilization Management Nurse Jobs in Cayce, SC, US

Responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating options to facilitate appropriate healthcare services. Communicates with providers, identifies members for referral opportunities, and promotes quality effectiveness of healthcare services. Requires proficien...

Conducts utilization reviews to determine if patients are receiving appropriate care based on illness severity. Monitors patient charts, evaluates concurrent care, reviews treatment plans, and consults with providers. Ensures adherence to regulatory requirements and promotes appropriate communicatio...