- 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
- 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
- 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
- Evolent (Bismarck, ND)
- …The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the ... appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership....to company policies and procedures. + Documents communications with medical office staff and/or MD provider as required. +… more
- Fujifilm (Bismarck, ND)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… 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
- CVS Health (Bismarck, ND)
- …Manager role includes: -Collaborate with an interdisciplinary care management team ( nurse case managers, medical directors, dietitians, social workers) to ... of a care management team -Currently and on a daily basis applies clinical knowledge to review medications and resolve different disease management scenarios… 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
- 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)
- **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
- 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
- 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