- Evolent (Bismarck, ND)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Cognizant (Bismarck, ND)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. + Medical Necessity Reviews can… more
- CenterWell (Bismarck, ND)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... to work every other holiday.** The **Care Manager, Telephonic Nurse ** helps to ensure optimal continuity of care for...Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services +… more
- BioLife Plasma Services (Bismarck, ND)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife ... of laboratory test results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works under the guidance of… more
- Datavant (Bismarck, ND)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Amergis (Bismarck, ND)
- …disability examinations for veterans in accordance with VBA guidelines. + Review medical records and document findings using standardized templates. ... We are seeking a compassionate anddetail-oriented Nurse Practitioner (NP) to join our team insupporting disabled veterans through the Veterans BenefitsAdministration… more
- Humana (Bismarck, ND)
- …effectively communicate a meaningful narrative with those findings + Proven ability to perform clinical reviews and review medical records + Ability to ... of our caring community and help us put health first** The Senior Clinical Medical /Financial Risk Evaluation Professional is responsible for supporting the… more
- CenterWell (Bismarck, ND)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Oracle (Bismarck, ND)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- Zurich NA (Bismarck, ND)
- Sr Supplier Medical Process Specialist 128416 Zurich North America is seeking am experienced Sr. Supplier Medical Process Specialist to join our team in one of ... commitment to work/life balance, and outstanding culture. As a Sr. Supplier Medical Process Specialist, you will manage supplier performance and work product in… more
- Humana (Bismarck, ND)
- …our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration...of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills,… more
- Oracle (Bismarck, ND)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will… more
- Catholic Health Initiatives (Bismarck, ND)
- **Job Summary and Responsibilities** Empowering Recovery: Registered Nurse (RN) - Partial Hospitalization Program (PHP) **Are you a compassionate and skilled ... Registered Nurse passionate about behavioral health and making a lasting...members, community resources, and other healthcare professionals. *Conducts utilization review : Act as a liaison with insurance companies by… more
- Sedgwick (Bismarck, ND)
- …**PRIMARY PURPOSE** **:** To manage complex high-exposure general liability claims; to review medical treatment records associated with general liability, bodily ... related clinical nursing experience to include two (2) years nurse consultant experience or equivalent combination of education and experience required.… more
- Catholic Health Initiatives (Bismarck, ND)
- …or a compact state. + **The Experience:** Bring 2-3 years of robust clinical experience, predominantly in medical /surgical nursing. This is where your ... lives? Do you dream of a role where your clinical expertise meets your passion for advocacy? Look no...Bismarck is actively seeking a dynamic and dedicated Registered Nurse Case Manager to join our exceptional team.** **This… more
- Merck (Bismarck, ND)
- **Job Description** Our Sales team support our customers by providing clinical information about products, educational information, clinical training programs ... impact of those options on the patient. Must understand impact and use of clinical trials in multiple tumor types/therapies, both in impact on promoted products and… more
- CenterWell (Bismarck, ND)
- …are excited to offer the role of Virtual Physician Collaborator for CenterWell Medical Group, a new virtual care delivery group within CenterWell Senior Primary ... in care, ensuring timeless access to important medications and solving urgent clinical needs. This Virtual Physician Collaborator shares in our vision to innovate… more
- BioLife Plasma Services (Bismarck, ND)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. _BioLife ... results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works...Medical Support Specialist + Two years in a clinical or hospital setting **More about us:** ** **… more
- Highmark Health (Bismarck, ND)
- …and retrospective claims review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or… more
- Merck (Bismarck, ND)
- …(Oncology group purchasing organizations, wholesalers, and specialty pharmacies). + Review and evaluate patterns for products purchased and prescribed (outpatient ... the in-scope customer team: Customer Team Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more.… more