- Humana (Bismarck, ND)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Humana (Bismarck, ND)
- …Lead- Florida develops, maintains, and/or operationalizes formularies related to coverage, utilization management edits, or clinical coverage policies ... Develops corporate communications to be shared with senior leadership. Supports trend management by conducting analysis of drug spend, utilization , and/or… more
- Highmark Health (Bismarck, ND)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- Evolent (Bismarck, ND)
- …is responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under ... directed by the office of the Chief Medical Officer. + Responsible for clinical conversations with providers and their office staff regarding medical necessity… more
- Prime Therapeutics (Bismarck, ND)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... visa or residency sponsorship **Additional Qualifications** + 3-5 years' experience in clinical operations, quality, network, pharmacy or project management OR a… more
- Evolent (Bismarck, ND)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Sanford Health (Bismarck, ND)
- …applicable experience. **Department Details** Flexible work schedule. **Job Summary** The Clinical Informatics Analyst demonstrates a clinical background with ... of the electronic health record (EHR) and other technology that enhances clinical practice. Acts as a liaison between assigned departments, facilities, providers and… more
- Evolent (Bismarck, ND)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Highmark Health (Bismarck, ND)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Evolent (Bismarck, ND)
- …Cardiologist)** Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical ... appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and clinical staff to address complex cases and… more
- Parexel (Bismarck, ND)
- …Data Management Lead to join our team. If you have a passion for clinical research, strong project management skills, and a knack for data management , ... Science, OR equivalent industry experience. + 7+ years experience in pharmaceutical/biotech clinical data management / Biometrics ( clinical trial data… more
- Evolent (Bismarck, ND)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Bismarck, ND)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Bismarck, ND)
- …Field Medical Director, Physical Medicine and Rehab you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Bismarck, ND)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** . Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Oracle (Bismarck, ND)
- …user efficiencies, improved care coordination, reduced readmissions, increased access and utilization , and enhanced clinical workflows. * Training & Education: ... achieving health network goals. Key Responsibilities: * Client Consultation & Relationship Management : o Serve as the strategic lead for client engagements, working… more
- Highmark Health (Bismarck, ND)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding, mentoring, or providing senior-level… more
- Highmark Health (Bismarck, ND)
- …program and project management OR d) management of professional analytic staff in a business, clinical or technology function + 5-7 years of experience ... of various projects and data analysis related to Medical Policy and Utilization Management . **ESSENTIAL RESPONSIBILITIES** + Perform management … more
- Evolent (Bismarck, ND)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with… more
- Oracle (Bismarck, ND)
- …+ **Informatics and Strategy** : Work as intermediaries between IT professionals and clinical staff , ensuring that technological changes align with clinical ... providers, nurses, and pharmacists. This role requires a unique blend of clinical expertise, leadership, informatics, change management , and data science skills.… more