- Evolent (St. Paul, MN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse , you will be a key member of the utilization ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Sharecare (St. Paul, MN)
- …affordable for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals ... and cost-effective manner while ensuring high quality care. The Clinical Registered Nurse coordinates with the Primary...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Elevance Health (Mendota Heights, MN)
- ** Nurse Reviewer I** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum ... integration, and ensures essential face-to-face onboarding and skill development. The ** Nurse Reviewer I** is responsible for conducting preauthorization, out… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim denial ... review and addresses the coding components of said claims. + Reviews insurance coding-related denials, including but not limited to: Diagnosis codes not supported, incorrect or invalid CPT/HCPCS Codes, Modifier issues, and/or general coding error denials.… more
- CVS Health (St. Paul, MN)
- …clients - Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... needs to ensure appropriate administration of benefits - Applies clinical judgment to the incorporation of strategies designed to...**Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- CVS Health (St. Paul, MN)
- …clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... needs to ensure appropriate administration of benefits. + Applies clinical judgment to the incorporation of strategies designed to...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- BioLife Plasma Services (Mounds View, MN)
- …Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife Plasma Services is a subsidiary of ... determine donor eligibility to donate plasma, management of donor adverse events, review of laboratory test results, and donor notification of unsuitable test… more
- BioLife Plasma Services (Mounds View, MN)
- …Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife Plasma Services is a subsidiary of ... determine donor eligibility to donate plasma, management of donor adverse events, review of laboratory test results, and donor notification of unsuitable test… more
- Sedgwick (St. Paul, MN)
- …Candidates must live within the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on ... Fortune Best Workplaces in Financial Services & Insurance Remote Accommodations Clinical Specialist- Bilingual Hindi, Japanese, Mandarin or more **We are looking… more
- St Croix Hospice (Vadnais Heights, MN)
- Manager of Clinical Services Job Details Level Management Job Location Vadnais Heights MN - Vadnais Heights, MN Education Level 2 Year Degree Job Shift Day Job ... Category Management Description The Manager of Clinical Services is responsible for ensuring that patient care...variety of means such as home visits, conferences, record review and the services provided by clinicians; discusses and… more
- Elevance Health (Mendota Heights, MN)
- **Diagnosis Related Group Clinical Validation Auditor-RN** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... face-to-face onboarding and skill development. The **Diagnosis Related Group Clinical Validation Auditor** is responsible for auditing inpatient medical records… more
- Fairview Health Services (St. Paul, MN)
- …+ Performance improvement, project management and/or lean skills + MN Registered Nurse (RN) License or + Certified Clinical Documentation Specialist (CCDS) ... & Education over CDI and Inpatient Coding works with information technology and clinical operations to improve documentation templates and alerts by disease type to… more
- CVS Health (St. Paul, MN)
- …a clinical pharmacist - Currently and on a daily basis applies clinical knowledge to review medications and resolve different disease management scenarios ... and offering appropriate treatment options to provider. - Demonstrated ability to review and apply clinical literature/pharmacy resources to provide clinical… more
- Presbyterian Homes and Services (Roseville, MN)
- … to assure appropriate RUGs category is achieved through the capture of appropriate clinical information. + Perform monthly QI/QM review for assigned region and ... MDS Nurses. + Complete triple check for assigned region ( Review UB04's for clinical billing), review...and management for your assigned region. Qualifications + Registered nurse with current licensure the State Board of Nursing… more
- Surgery Care Affiliates (Woodbury, MN)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... If you join our team, they will. Responsibilities The Nurse Manager is responsible for the overall functioning of...perianesthesia and/or the OR. + Ensures adequate technical and clinical team coverage to meet scheduled cases + Ensures… more
- Fresenius Medical Center (Hastings, MN)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine...activities. + Enters all treatment data into the designated clinical application in an accurate and timely manner. +… more
- Public Consulting Group (St. Paul, MN)
- …learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager will be ... efficient, equitable, and client-centered * Handles case assignments, draft service plans, review case progress, and manages ongoing care needs * Travels within the… more
- Sedgwick (St. Paul, MN)
- … Consultant) Certification or training preferred. **Experience** Five (5) years related clinical nursing experience and two (2) years nurse consultant experience ... Services & Insurance RN Consultant Sr - Professional Liability **Prior Legal Nurse Consulting expereince highly preferred in order to be considered.** **PRIMARY… more
- Sevita (Maplewood, MN)
- …every day. Join us today, and experience a career well lived. ** Clinical Specialist** **$57,500 annually** Looking for rewarding work in an organization dedicated ... to making a positive impact in the lives of others? Bring your clinical and interpersonal skills to a team-based workplace that puts people first. As the Clinical… more
- University of St. Thomas (St. Paul, MN)
- …instructors are for a pooled, adjunct faculty position for continuous recruitment. Review of candidates is typically done two times annually - spring/summer and ... late fall/winter. Teaching load generally includes clinical instruction and may include theory instruction, depending upon program needs and enrollments.… more