- CVS Health (Bismarck, ND)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Bismarck, ND)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... 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 … more
- Humana (Bismarck, ND)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… 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. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- CVS Health (Bismarck, ND)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… 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 ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Catholic Health Initiatives (Bismarck, ND)
- …Responsibilities** **CHI St Alexius Health Bismarck is** **seeking a dedicated and experienced Clinical Manager to lead our NICU & Children's Unit. This is a vital ... Additional areas supported include but not limited to the following: case management and social work, quality, and infection prevention. Serves as a behavior… 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)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Oracle (Bismarck, ND)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… 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! ... 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
- 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 ... planning, facilitation and coordination of discharge needs. Enhances the quality of clinical outcomes and patient satisfaction while managing the cost of care.… 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
- Highmark Health (Bismarck, ND)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more