- Evolent (St. Paul, MN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (St. Paul, MN)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Shield of Minnesota Position Title: Care Manager PreService & Retrospective - Appeals Location: Remote Career Area: Health Services About Blue Cross and Blue ... provider performance and member satisfaction. Required Skills and Experience * Registered nurse with current MN license and no existing or pending restrictions. *… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / This position is a*0.8 FTE (8 ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Fairview Health Services (St. Paul, MN)
- …analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a working knowledge ... research and timely and accurate actions including preparing and submitting appropriate appeals or re-billing of claims to resolve coding denials to ensure… more
- Sharecare (St. Paul, MN)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- TEKsystems (Minneapolis, MN)
- …their benefit structure(s) * Requests medical documentation from providers not limited to nurse case reviewers and clinical staff to build on claims for medical ... Updates customers and customer support team on status. Assists in coordinating appeals if required by insurance payer. * Maintains knowledge of the following:… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …* Identifies opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health ... of the department. * Guides member through the Prior Authorization and Appeals process. * Engage providers telephonically in reviewing and understanding treatment… more