Medicaid Clinical Experience Medicare Specialist (Jobs in Columbia, SC)   Requirement id 150857 Job title Specialist Job location in Columbia, SC Skills required Financial Systems, Medicaid, Utilization Review, Clinical Experience Medicare Open Date 10-Dec-2024 Close Date Job type Contract Duration 12 Months Compensation DOE Status requirement --- Job interview type ---    Email Recruiter: coolsoft Job Description Specialist: Financial Systems, Medicaid, Utilization Review, Clinical Experience Medicare No of Submissions : 2 Start date : 01/14/2025 Submission deadline : 12/18/2024 Client Info : Department of Health and Human Services Note: Q) INTERVIEW PROCESS (who will conduct i/v, phone or in-person, how many rounds of i/v)? A) The interviews will be conducted by a team either in-person or via video conferencing. Q) SCHEDULE INTERVIEW: How soon can you schedule an interview (date / times)? A) Once qualified resumes and candidates have been received. Description : **Please read - must have the requirements listed to be submitted.** Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse. SCOPE OF THE PROJECT: This project is a multi-year effort which primarily focuses on providing consulting services to operations and policy staff for the current MMIS. The current positions focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers. A long-term plan includes participating and providing guidance in the administrative approach for the replacement Medicaid management system. It is necessary to build and sustain a strong clinical staff who understand medical coding, medical necessity review, treatment, and determinations. OBJECTIVES TO BE FULFILLED BY CANDIDATE: Performs medical record and claims review to ensure proper guidelines have been followed and medical necessity criteria has been met. Specific duties include, but are not limited to: • Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for services. • Maintain a thorough knowledge of medical coding and collaborates with team members to share knowledge and adjust processes, as necessary to comply with requirements. Reviews and maintains knowledge of relevant SC Medicaid Policies and Procedures impacting claims approval processes. • Collaborate with other agency employees and external stakeholders, as necessary. Acts with proactive intent to improve claims related outcomes while considering input from team and making the best decisions to align with agency objectives and provider and member support. • Other project-related duties. REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE): • Current, active and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse. • 2 years healthcare experience that demonstrates expertise in conducting Utilization Reviews and/or Prior Authorization or related experience • 1 year experience working with IT developers/programmers in a payor environment • Knowledge of Medicare and/or Medicaid regulations. • Medical record abstracting skills. • Strong knowledge of formal business process documentation. • Ability to effectively communicate with executive management, line management, project management, and team members. PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE): • Strong clinical assessment and critical thinking skills. • Knowledge of the organization of medical records, medical terminology, and disease process. • Excellent verbal and written communication skills. • Flexibility and strong organizational skills. • Proficiency in Microsoft Office and internet/web navigation. • Ability to work in a team environment. REQUIRED EDUCATION: Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN) REQUIRED CERTIFICATIONS: Must have current, active, and non-restricted licensure by the State of South Caro   Call 502-379-4456 Ext 100 for more details. Please provide Requirement id: 150857 while calling.   Other jobs in SC: Beaufort (1), Blythewod (2), Blythewood (3), Charleston (17), Columbia (37), Greenville (4), Hartsville (2), North Charleston (2), Overland Park (1), San Francisco (1), SENECA (4), South Carolina (1), Spartanburg (3), Unknown (2),    Financial Systems job openings in other states Jobs List SAO Finance (A/P) Business Analyst (746367) Create date: 05-Sep-2024 No of Submissions : 2 Start date : 09/10/2024 End Date : 06/30/2025 Submission deadline : 10/07/2024 Client Info : SAO Note: * Agency Interview Type : Either Web Cam or In Person * Hybrid Description : Duties & Responsibilities: The .... 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Please submit candidates above rate as well if they have all the required qualifications. Candidate must be our W2 Employee. Candidate must be local : Yes We should submit only GC,GC - EAD, L2-EAD,H4-EAD and Citizens. Job Description : Financial .... (This job is for - Accounting Jobs in FL Miami Analyst - (in Miami, FL)) Finance Systems Analyst - 41253 Create date: 11-Dec-2018 Candidate must be our own W2 Employee We should submit only GC,GC - EAD, L2-EAD,H4-EAD and Citizens Job Description : Title: Financial Systems Analyst Contract: Long term open - ended Job Details: The Finance System Analyst is responsible for administration an.... (This job is for - KOFAXAccounting Jobs in FL Tampa Analyst - (in Tampa, FL))    Financial Systems job openings in SC Jobs List SR WEB ENGINEER - 10416-1 Create date: 13-Jun-2022 start date:7/15/2022 submission deadline:6/20/2022 client info : Department of Motor Vehicles Note: * INTERVIEW PROCESS (who will conduct i/v, phone or in-person, how many rounds of i/vs)? * Applications Systems Manager and Development Manager conducting interviews. * Interviews wi.... (This job is for - RDBMS Jobs in SC BLYTHEWOOD Engineer - (in Blythewood, SC)) BUSINESS PROCESS ANALYST - 9370-1 Create date: 09-Jun-2020 Start Date :07/01/2020 Submission Deadline :06/16/2020 Client Info : Department of Motor Vehicles Note : * INTERVIEW PROCESS (who will conduct i/v, phone or in-person, how many rounds of i/vs)? Both business and IT development staff will be interviewing the candidates. * SCHEDUL.... (This job is for - job Jobs in SC BLYTHEWOOD Analyst - (in Blythewood, SC)) (Specialist: Financial Systems, Medicaid, Utilization Review, Clinical Experience Medicare in Columbia, SC)

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