- CenterWell (St. Paul, MN)
- …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …improvement initiatives *Education*: * Attains and maintains current knowledge in UR/ UM practices, payer requirements, clinical guidelines, and regulations ... *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / This position is a*0.6 FTE (6… more
- Humana (St. Paul, MN)
- …a part of our caring community and help us put health first** The Telephonic Nurse Case Manager will be a member of the In-Home Case Management Team, providing a ... beneficiary's capacity for self- care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care....and to enhance quality of medical care. The **Telephonic Nurse Case Manager** will collect and document data to… more
- Highmark Health (St. Paul, MN)
- …experience, or provider operations and/or health insurance experience + 1 year in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year ... over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and… more
- Datavant (St. Paul, MN)
- …recognized medical necessity criteria and standards of care, along with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed ... Practical Nurse or Registered Nurse well versed in...denials and appeal writing for inpatient admission. Experience with clinical criteria resources and payor guidelines. **You will:** +… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …unspecified code and modifier code reviews. Your Responsibilities * Applies clinical experience, health plan benefit structure and claims payment knowledge to ... pre- service and retrospective reviews by gathering relevant and comprehensive clinical data through multiple sources. * Leverages clinical knowledge, business… more
- Sharecare (St. Paul, MN)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision… more