Utilization Manager Jobs in Fargo
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CommunityCare-Fargo
to support timely utilization decisions
• Provide clinical consultation on complex medication requests and coverage determinations
• Support development and maintenance of medical drug utilization management programs
• Develop and maintain evidence-based...
Salient-Fargo
and the claim lifecycle, including basic adjudication and 837/835 concepts (NYS Medicaid experience a plus).
• Exposure to health data formats such as enrollment, services, lab, and pharmacy.
• Awareness of utilization management, care coordination, quality...
mindmatch.ai -
Huron Consulting Group-Fargo
quality incentive programs, and network optimization
• Experience leading complex healthcare analytics and modeling (e.g., HCC risk adjustment, RAF optimization, clinical risk stratification, cost trend analysis, utilization management, population health...
UnitedHealth Group-Fargo
Overview
As Medical Director, you guide clinical coverage determinations within Enterprise Clinical Services, collaborating with leadership to ensure high-quality, cost-effective patient care. You lead utilization management activities and engage...
UnitedHealth Group-Fargo
Overview
In this role you support authorization decisions for psychiatric and chemical dependency care, working within Utilization Management to ensure medical necessity and efficient care transitions. You will handle data entry, coordination...
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