- CenterWell (Bismarck, ND)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Bismarck, ND)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Bismarck, ND)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Evolent (Bismarck, ND)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Sanford Health (Mandan, ND)
- …Graduate from an accredited practical nursing program as a Licensed Practical Nurse . If position requires IV therapy/ management skills, the following is ... Sign On Bonus Available! **Department Details** Nursing Home Outreach nurse will work closely with 7 providers to provide...allows for a lot of autonomy, independent work and utilization of critical thinking skills with no direct patient… 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...**This role focuses on the behavioral health and case management aspects of patient care, where you will:** *Collaborate… more
- Sharecare (Bismarck, ND)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Highmark Health (Bismarck, ND)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- CVS Health (Bismarck, ND)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… more
- Catholic Health Initiatives (Bismarck, ND)
- …+ **Bonus Points (But Not Required!):** If you have experience in Case Management , discharge planning, or utilization review, consider yourself one step ahead! ... CHI St. Alexius Health Bismarck is actively seeking a dynamic and dedicated Registered Nurse Case Manager to join our exceptional team.** **This isn't just a job;… more
- Sanford Health (Bismarck, ND)
- …candidates **Job Summary** Provides expertise and leadership to ensure effective resource management for patient care delivery across the care continuum for assigned ... patient wellness through evidenced based practice, improved care outcomes, efficient utilization of health services, and appropriate level of care for patients… more
- Catholic Health Initiatives (Bismarck, ND)
- …Additional areas supported include but not limited to the following: case management and social work, quality, and infection prevention. Serves as a behavior ... methods in line with system policies and processes. 7. Ensures optimal utilization of department resources within guidelines set forth through capital and… more
- Oracle (Bismarck, ND)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more
- Good Samaritan (Bismarck, ND)
- …Prioritizes responsibilities while working autonomously. Plans and oversees the utilization of resources and designs of work processes. **Qualifications** Associate ... social services or creative activities. Minimum of one year previous leadership/ management experience preferred. In a skilled long-term care facility, applicants… more
- Good Samaritan (Bismarck, ND)
- …skills. Prioritizes responsibilities while working autonomously. Plans and oversees the utilization of resources and designs of work processes. Selects, develops and ... social services or creative activities. Minimum of one year previous leadership/ management experience preferred. In a skilled long-term care facility, applicants… more