- Justice, Bureau of Prisons/Federal Prison System (Rochester, MN)
- …Department of a Bureau of Prisons, Medical Referral Center (MRC). Serves as the Utilization Review Nurse and assists in quality improvement activities ... to the appropriateness of medical care and communicates findings to the Utilization Review Committee. Applies predetermined evidence-based criteria sets and… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …needs and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for ... of Minnesota. Some positions may require specialized certifications(s). **Title:** *Staff Nurse - Utilization Review (Float)* **Location:**… more
- Cognizant (St. Paul, MN)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional Care Team.This is a full-time role and will be required to work ... this position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include… more
- Sharecare (St. Paul, MN)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- CVS Health (MN)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Lincoln Financial (St. Paul, MN)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Fresenius Medical Center (Coon Rapids, MN)
- …day (Excel skills needed). **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the Inpatient Services RN, for ... duties, as assigned by the Program Manager. The Inpatient Services Charge Nurse ensures appropriate provision of Acute Dialysis Services and treatments within… more
- Fairview Health Services (St. Paul, MN)
- …to Fairview Hospitalist APPs **Fairview** is seeking an experienced **Hospitalist** ** Nurse Practitioner** to perform triage work in the System Operations Center ... hospital, tertiary hospitals, and community hospitals. This role ensures optimal utilization of system resources by coordinating with patient placement nurses,… more
- Fairview Health Services (Maplewood, MN)
- …services provided + Completes the requirements of various payers and utilization management reviewers to obtain authorization for treatment. Demonstrates the ability ... + Journal club + Journal article critique and circulation + Literature review + Development of standard/pathway/guideline for patient care + Presentation + Research… more
- Evolent (St. Paul, MN)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Mayo Clinic (Rochester, MN)
- …and multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization Review , including concurrent admission status and continued stay ... to work well within a creative and challenging work environment. Experience in utilization review , ability to navigate medical records, value based purchasing… more
- Highmark Health (St. Paul, MN)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Fresenius Medical Center (Shakopee, MN)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …or related field * Minimum 3 years of experience in clinical care, utilization review , case management, or clinical denials/appeals -OR- * An approved ... *_SUMMARY:_* We are currently seeking a Utilization Management Analyst to join our Denials Analysis....denials prevention program * Collaborate with UM staff to review for medical necessity and authorization-related denials to determine… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and ... health care services, application of criteria to ensure appropriate resource utilization , identification of referrals to a Health Coach/case management, and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …across the continuum of care by leveraging member partnership, pre-service clinical utilization review , case and disease management processes, skill sets and ... * Identifies opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health… more
- Minnesota State (White, MN)
- …+ Mentor and advise students. + Participate in program/department accreditation and program review . + Attend department and college meetings. + Teach courses at a ... of verified related paid work experience as a registered nurse at the professional level. + As a registered...willingness to teach online courses and electronic health record utilization . + Experience in or demonstrated commitment to fostering… more
- Sedgwick (St. Paul, MN)
- …(10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. **Skills & ... the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim denial, disability...+ Knowledge of ADAA and FMLA + Knowledge of utilization review procedures + Knowledge of clinical… more
- Accura Healthcare (Waite Park, MN)
- …and personalized assessments for use in the evaluation of quality of care and utilization review for the purpose of clinical reimbursement. The MDS Coordinator ... medical records. QUALIFICATIONS: + Current licensure as a Registered Nurse (RN) in the applicable state, without restrictions, and/or...Click Care (PCC) preferred. + On call shared between nurse managers - every 4th weekend on call +… more