- Humana (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- Cognizant (St. Paul, MN)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (St. Paul, MN)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / This position is a*0.6 FTE ... needs and may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...in confidentiality, integrity, creativity, and initiative */License/Certifications:/* * Current Registered Nurse licensure upon hire * National… more
- Fresenius Medical Center (Shakopee, MN)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …care coordination, and transition of care between settings. Required Skills and Experience * Registered nurse with current MN license and with no restrictions. * ... Shield of Minnesota Position Title: Care Advocacy Case Manager RN - Bilingual Spanish Location: Remote Career Area: Health...* 1+ years of managed care experience; eg case management /health coach, utilization management and/or… more
- Fairview Health Services (Edina, MN)
- …with electronic medical record systems; excellent written and verbal communication skills + MN Registered Nurse ( RN ) License in good standing + Drivers ... not limited to: assessment, care planning, service coordination and referral, transition management , utilization management and quality assurance. The care… more
- Highmark Health (St. Paul, MN)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …coordination, and transition of care between settings. Required Skills and Experience * Registered Nurse licensure in the state of Minnesota with no ... Blue Cross and Blue Shield of Minnesota Position Title: RN Case Manager - Commercial TOC Location: Remote Career...* 1+ years of managed care experience; eg case management /health coach, utilization management and/or… more
- Adecco US, Inc. (Minneapolis, MN)
- …. Experience applying benefits and criteria to clinical reviews . Utilization Management , pre-authorization, concurrent review, or appeals experience **Why ... Adecco Healthcare & Life Sciences is hiring remote RN Appeals Reviewers! This role is remote /...and Holiday pay upon meeting eligibility criteria. **IMPORTANT:** This ** Registered Nurse ** role is being recruited for… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …community events to engage with members. Required Skills and Experience * Registered Nurse with Psychiatric experience or Behavioral Health Professional that ... * 1+ years of managed care experience, eg case management /health coach, utilization management and/or auditing experience. Compensation and Benefits:… more
- Highmark Health (St. Paul, MN)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …* 1+ years of medical call center or managed care experience; eg case management , utilization management * All relevant experience including work, education, ... Guide is a critical component of BCBSMs Integrated Health Management team. The position exists to provide member, provider...clinical and service availability. Required Skills and Experience * RN with MN license or LSW with no restrictions… more
- Evolent (St. Paul, MN)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... in a regulatory role (preferred). **LICENSE/CERTIFICATION:** Current, unrestricted state PA or RN /NP license in medicine or required specialty. Of a PA, obtaining a… more
- CenterWell (Brooklyn Park, MN)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... on-site at our** **Brooklyn Park, MN** **branch location.** The ** RN Clinical Manager** coordinates and oversees all direct care...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Datavant (St. Paul, MN)
- …job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Parexel (St. Paul, MN)
- **Job Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** At ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
- Good Samaritan (Waconia, MN)
- …act and standards of nursing care, and a working knowledge of administrative and management techniques. Currently holds an unencumbered RN license with the State ... providers to plan, implement and evaluate care. Includes personal care management , medication administration, care planning, scheduling physician visits, setting up… more