- CVS Health (St. Paul, MN)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in CST and MST zones.… more
- Humana (St. Paul, MN)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Baylor Scott & White Health (St. Paul, MN)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- Elevance Health (Mendota Heights, MN)
- ** Nurse Reviewer I** This role enables associates to...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... state(s) required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Evolent (St. Paul, MN)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...or Oregon License Required** + Associate or Bachelors in Nursing (Must be a Registered Nurse ) -… more
- Humana (St. Paul, MN)
- …course of action. **Key Functions:** + Serves as a liaison between Humana utilization management (UM) operations, Humana's Risk and Compliance lines of defense, ... regarding prior authorization reviews, prepayment retrospective reviews, and any additional utilization management functions. + Develop and implement … more
- CVS Health (St. Paul, MN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- CVS Health (St. Paul, MN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Medical/Surgical, Oncology or Specialty Pharmacy. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or … more
- Humana (St. Paul, MN)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Highmark Health (St. Paul, MN)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Bluestone Physician Services (St. Paul, MN)
- …with primary care teams to ensure high quality team-based care + Use utilization management tools to facilitate appropriate transitional care management ... as to acute settings with the goal of reducing utilization and unnecessary costs + Work to increase coordination...Nurse + 3-5 years of experience in case/care management or care coordination + Experience working directly with… more
- Bluestone Physician Services (Mahtomedi, MN)
- …medical care teams to ensure health care quality measures are met and use utilization management tools to meet value-based goals + Supporting members during ... or more years of experience working with the geriatric population in case management /care coordination, Home Care, Nursing Home, TCU or Assisted Living settings… more
- Elevance Health (Mendota Heights, MN)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... work counseling or a related behavioral health field or a degree in nursing , and minimum of 3 years of experience with facility-based and/or outpatient psychiatric… more
- Presbyterian Homes and Services (Roseville, MN)
- …plan development and management for your assigned region. Qualifications + Registered nurse with current licensure the State Board of Nursing in state(s) in ... of the RAI process + Experience with MDS completion, reimbursement, clinical resource utilization and/or case management + Ability to work flexible work hours… more
- Sedgwick (St. Paul, MN)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business ... lines; and to provide expertise in client specific case management and utilization review requirements and ensure...territory of the United States required. Certification in case management required. Bachelor's degree in nursing (BSN)… more
- Sharecare (St. Paul, MN)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse...Hours are on Central Standard Time. _ A compact nursing license is required for this position_ **Essential Job… more
- United Therapeutics (St. Paul, MN)
- …and development of clinical content + Demonstrated high competency in clinical management , conversations, patient management , and clinical/ nursing processes ... currently an option. Who you are You are experienced nurse and an expert in all things PAH. You...maintain key external relationships within regions + Strong project management skills + Demonstrates expertise in nursing /… more
- Highmark Health (St. Paul, MN)
- … **SKILLS** + Deep Clincal Expertise -extensive knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a ... and other stakeholders. **EDUCATION** **Required** + Bachelor's degree in Nursing , Pharmacist, Physician Assistant or Clinical field **Substitutions** + None… more
- Merck (St. Paul, MN)
- …Execute engagement strategies that align with market needs, enhance appropriate product utilization , and support the company's HIV portfolio. + Collaborate with AHPs ... community educator identification to ensure alignment with corporate objectives. **Account Management & Business Performance** + Manage key accounts across Ryan… more
- Presbyterian Homes and Services (St. Paul, MN)
- …regulations and established best practices + Manage the performance management process (recruitment, selection, orientation, supervision, evaluation and termination) ... qualities and skills to develop and motivate staff, to oversee the utilization of resources, and to design work processes. Ability to prioritize responsibilities.… more