- 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
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- Summary The Home and Community Based Services program Registered Nurse is a member of the interdisciplinary team responsible for providing centralized, standardized, ... right time. Responsibilities **These positions may be filled by a Registered Nurse , Physical Therapist, or Occupational Therapist. These positions are advertised on… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department in a*/*FLOAT*/*/assignment to support Inpatient, Psych and the ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …cycle teams. The UM Analyst helps ensure regulatory compliance, timely appeals , and reduction of avoidable denials through proactive collaboration and data-driven ... Collaborate with UM staff to draft and submit compelling clinical appeals , including summaries and supporting documentation in accordance with payer-specific… 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
- 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
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- …right time. Responsibilities **These positions may be filled by a Registered Nurse , Physical Therapist, or Occupational Therapist. These positions are advertised on ... eligibility, service delivery, location, level of care discharge planning, appeals process, and performance improvement. Conducts comprehensive clinical reviews of… more
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- …right time. Responsibilities **These positions may be filled by a Registered Nurse , Physical Therapist, or Occupational Therapist. These positions are advertised on ... eligibility, service delivery, location, level of care discharge planning, appeals process, and performance improvement. Conducts comprehensive clinical reviews of… more