- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CenterWell (St. Paul, MN)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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
- Humana (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Fairview Health Services (Maplewood, MN)
- …not limited to: assessment, care planning, service coordination and referral, transition management , utilization management and quality assurance. The care ... Medicaid benefits and senior care industry + Public Health Nurse + Certification in case management +...Public Health Nurse + Certification in case management + gerontological nursing **Benefit Overview** Fairview offers a… more
- Mayo Clinic (Rochester, MN)
- …a dedicated professional to join our team as Infection Preventionist/Quality Assurance (IPQA) Nurse . As IPQA Nurse , you will be collaborating with leadership to ... educational and clinical training programs. + Developing policies for risk management systems to protect residents, visitors, and employees. + Computer hardware,… more
- Actalent (Rochester, MN)
- Infection Preventionist / Quality Assurance Nurse Job Description The Infection Preventionist/Quality Assurance (IP/QA) nurse collaborates with leadership to ... educational and clinical training programs, and develop policies for risk management systems to protect residents, visitors, and employees. + Incorporate computer… 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
- 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
- Justice, Bureau of Prisons/Federal Prison System (Rochester, MN)
- …wound care assessment for patients referred for consultation, treatment, and management in order to identify wound etiology, formulate goals (healing, maintenance, ... by an established protocol identifying expected outcomes for the treatment and management of wounds. Provides for evaluation of wound healing goals (healing,… 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 ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… more
- Elevance Health (Durand, WI)
- …communities. The **LTSS Service Coordinator-RN Clinician** is responsible for overall management of member's case within the scope of licensure, develops, monitors, ... face-to-face functional assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health,… more
- Mayo Clinic (Rochester, MN)
- …multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization Review, including concurrent admission status and continued stay clinical ... terminology and disease processes. Knowledge of CPT coding, resource management systems, electronic medical record and personal computers beneficial. Demonstrated… more
- Fresenius Medical Center (Hastings, 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
- Datavant (St. Paul, MN)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... 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 versed in… more
- Sharecare (St. Paul, MN)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… 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 ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Fairview Health Services (Maplewood, MN)
- …not limited to assessment, care planning, service coordination and referral, transition management , utilization management and quality assurance. The care ... Convenes interdisciplinary team members, as needed, for complex case management + Consults with FVP Nurse Care...complex case management + Consults with FVP Nurse Care Coordinator for members with complex health care… more
- Fairview Health Services (Woodbury, MN)
- …in promoting the practice of professional nursing as well as the development and utilization of resources. The PCS works cooperatively with the Nurse Manager, ... people we serve. The PCS participates in aspects of budgeting, performance management and human resources matters, including recruitment and the administration of… more
- Fairview Health Services (Cottage Grove, MN)
- …and protocols. + Actively participates in multidisciplinary team approach to case management + Participates in utilization and quality tools and activities ... Frequency:** **1:3** **low intensity - phone consultation only with first tier nurse triage** + **Fully integrated** Electronic Medical Record (EPIC). + Examines,… more