- Humana (Bismarck, ND)
- …a part of our caring community and help us put health first** The Weekend 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
- CVS Health (Bismarck, ND)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… 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
- Lincoln Financial (Bismarck, ND)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… 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 ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Evolent (Bismarck, ND)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Highmark Health (Bismarck, ND)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case 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 ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- CVS Health (Bismarck, ND)
- …research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes. Required Qualifications: ... Registered Nurse (RN) required. Working knowledge of problem solving and...all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit… more
- Highmark Health (Bismarck, ND)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more
- Sanford Health (Bismarck, ND)
- …$51.00 **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)
- **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
- Sanford Health (Bismarck, ND)
- …in the functions of the applicable technical software setting and process/ utilization improvement. Improves clinical patient care processes for quality patient ... and supports human resources administrative processing and procedures with staff management . May assist with providing feedback in the collection and preparation… more
- Good Samaritan (Bismarck, ND)
- …trends, external regulations, and internal policies that affect resource utilization and potentially, prior authorization. Depending on location, enters data ... into Customer Referral Management (CRM) and the electronic medical record (EMR) accurately....an unencumbered license in one of the following: Registered Nurse (RN), Licensed Practical Nurse (LPN), Occupational… more
- Lincoln Financial (Bismarck, ND)
- …in a behavioral health setting including 1 year in claims, disability management (STD/LTD), worker's compensation, utilization review, and or behavioral health ... You will collaborate with Independent Consulting Physicians, Claims Specialists, and Nurse Disability Consultants to assist with reviewing and assessing mental… 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
- 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