- Evolent (St. Paul, MN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse 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… more
- 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
- 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
- Presbyterian Homes and Services (Roseville, MN)
- …throughout the resident's stay. + Audit RUG grouper/MDS end splits, review all expedited appeals and ALJ level appeals . Perform concurrent MDS review to assure ... care plan development and management for your assigned region. Qualifications + Registered nurse with current licensure the State Board of Nursing in state(s) in… more