- Humana (St. Paul, MN)
- …a part of our caring community and help us put health first** The Weekend Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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 ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Lincoln Financial (St. Paul, MN)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… 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 ... *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including patient status, treatment plans, and healthcare… 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...to 5) years of professional leadership experience (ie, charge nurse , team leader, preceptor, committee chair, etc.) * Five… more
- CVS Health (St. Paul, MN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Fairview Health Services (Maplewood, MN)
- …for services provided + Completes the requirements of various payers and utilization management reviewers to obtain authorization for treatment. Demonstrates the ... as an interdisciplinary team member. Responsible, as assigned, for the management of caseload. **Job Expectations:** Works collaboratively with the physician and… more
- CVS Health (St. Paul, MN)
- …CM, discharge planning and/or home health care coordination experience + Previous Utilization Management experience, transitions of care and discharge planning ... members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention… 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 ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (St. Paul, MN)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Good Samaritan (Inver Grove Heights, MN)
- …This full-time 40 hours per week MDS Coordinator will be a part of our management team. Primary responsibilities will be MDS duties for the facility. 40 hours per ... weekend on-call rotation shared with the other supervisory staff. MN Registered Nurse , RN required. Prior MDS experience preferred. $15,000 Bonus Eligible! Qualifies… more
- Fairview Health Services (St. Paul, MN)
- **Job Overview** **Fairview Health Services** is seeking a full-time Nurse Practitioner **Medical Director** , **Acute and Diagnostic Services,** to provide ... ensure execution of strategic and operational plans. + Monitor clinic capacity and utilization to ensure access and meet community needs. + Partner with the… 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. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …operational quality within Medical Management for case management , disease management and utilization management . This position will provide input ... CMS guidelines. Audits capture case management , disease management , utilization management and delegate...accountabilities as assigned. Required Skills and Experience ⦁ Registered Nurse licensure in MN. ⦁ 3+ years of related… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …, and business case consultant for leadership as they relate to case/disease/ utilization management . * Coordinates the development, revision and implementation ... and cost control. Required Skills and Experience * Registered nurse or licensed behavioral health clinician (ie, LICSW, LPCC,...within insurance or health care setting in case/disease or utilization management * Bachelor's or Master's degree… more
- Fairview Health Services (Minneapolis, MN)
- …1 year RN experience + Registered Nurse **Preferred Qualifications** + Case Management Nurse + Basic Life Support (American Heart Assoc, Red Cross) **Benefit ... inpatient peds units at Masonic Children's Hospital. The Patient Care Management Coordinator provides comprehensive care coordination of patients as assigned. The… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Skills and Experiences * 2+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience (may be ... and Blue Shield of Minnesota Position Title: RN Specialist Complex Care Case Management Location: Remote Career Area: Health Services About Blue Cross and Blue… more
- Highmark Health (St. Paul, MN)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… 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 ... and member satisfaction. Required Skills and Experience * Registered nurse or licensed behavioral health clinician (ie LICSW, LPCC,...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Skills and Experience * 1+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience. * ... across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and… more