- State of Minnesota (St. Paul, MN)
- **Working Title: State Medical Review Team County Liaison** **Job Class: Human Services Program Specialist 2** **Agency: Human Services Dept** + **Job ... This position exists to fully evaluate, screen, and develop referrals made to the State Medical Review Team (SMRT) in accordance with program policies… more
- State of Minnesota (St. Paul, MN)
- …be eligible for telework._** **_Flexible work hours may be permitted with supervisor approval._** The State Medical Review Team (SMRT) Data and Systems ... Security Disability regulations, state and federal regulations, and policies governing State Medical Review Team (SMRT), Medical Assistance (MA),… more
- State of Minnesota (St. Paul, MN)
- …eligible for telework._** **Flexible work hours may be permitted with supervisor approval.** The State Medical Review Team (SMRT) Disability Program ... Training & Technical Advisor serves as a technical expert and leader within the State Medical Review Team (SMRT). This role advances staff competency,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:** *251532* ... may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the … more
- Humana (St. Paul, MN)
- …claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Supervisor, Claims Review works within ... in selection of methods, techniques, and analytical approach. The Supervisor, Claims Review partners with professional staff on pre-screening review by applying… more
- DC Group (Minneapolis, MN)
- …that sets us apart, fuels our growth, and makes us an exciting team to grow with! Requirements: + In-office position at Minneapolis, MN headquarters, candidate ... priorities within defined deadlines. + Direct experience with contract review is not required, but job experience in roles...of contact to relay contract information to internal sales team members or others as requested. + clarifying client… more
- DC Group (Minneapolis, MN)
- …that sets us apart, fuels our growth, and makes us an exciting team to grow with! Requirements: + In-office position at Minneapolis, MN headquarters, candidate ... Microsoft Word Track Changes. + Experience coordinating and collaborating on contract review aspects that require input between various departments such as the legal… more
- Humana (St. Paul, MN)
- …to operationalize this knowledge in their daily work specifically for DSNP. The Medical Director's work includes computer-based review of moderately complex to ... performed with minimal direction, but with support from other team members. The Medical Director enjoys working...other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare… more
- Humana (St. Paul, MN)
- …and will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Humana (St. Paul, MN)
- …high degree of integrity, professionalism, resourcefulness, and enjoy working in a team -based environment. Medical Directors support Humana value throughout all ... insurance, or other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed… more
- Otsuka America Pharmaceutical Inc. (St. Paul, MN)
- …teams + Utilize platforms like Veeva Vault, to manage content lifecycle and Medical Review submissions. + Track and report content usage and effectiveness, ... The Manager, Medical Core Content is a team -level...medical teams. + Serve as a champion for Medical Review / Promotional review … more
- Highmark Health (St. Paul, MN)
- …Specialties or the American Osteopathic Association Specialty Certifying Boards + Active medical state licensure required. Additional specific state ... and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may… more
- Humana (St. Paul, MN)
- …clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn North Central region state Medicaid ... will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to… more
- Travelers Insurance Company (St. Paul, MN)
- …which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State regulations and ... medical guidelines to establish medical review policies. Works in close collaboration...experience preferred + Proven ability to work in a team environment and collaborate on innovative projects + Demonstrated… more
- Evolent (St. Paul, MN)
- …by Medicare. + No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several ... within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure...in medicine or required specialty + Obtaining and maintaining medical licenses in the state you reside,… more
- Evolent (St. Paul, MN)
- …by Medicare. + No history of a major disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several ... care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more
- Humana (St. Paul, MN)
- …topics to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review of moderately complex to ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… more
- Evolent (St. Paul, MN)
- …or sanctioned by Medicare. . No history of disciplinary or legal action by a state medical board To ensure a secure hiring process we have implemented several ... clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure...in medicine or required specialty . Obtaining and maintaining medical licenses in the state you reside,… more
- Humana (St. Paul, MN)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- CenterWell (St. Paul, MN)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managedMedicaid,… more