- 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
- Mayo Clinic (Rochester, MN)
- …social workers, physicians and multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization Review, including concurrent admission ... helpful. Additional nursing experience in specialty area beneficial. Certification in Case Management (CCM or ACM- RN ) preferred. Internal applicants are required… 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. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… 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)
- …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
- Elevance Health (Durand, WI)
- …living, employment, and contributing to their communities. The **LTSS Service Coordinator- RN Clinician** is responsible for overall management of member's ... **LTSS Service Coordinator - RN Clinician ( RN Case Manager)** **Hiring...face-to-face functional assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health,… 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
- Bluestone Physician Services (Maplewood, MN)
- …medical care teams to ensure health care quality measures are met and use utilization management tools to meet value-based goals + Supporting members during ... safe discharge and follow up plan Qualifications : Education/Certification/Experience + Minnesota Registered Nurse license + OR Current MN Licensed Social Worker… 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
- 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 ... Three years in mental health or related setting **License/Certification/Registration** + Current Registered Nurse license in Minnesota + Basic Life Support… 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
- Mayo Clinic (Rochester, MN)
- …on Collegiate Nursing Education (CCNE) accredited nursing program + Current Minnesota Registered Nurse License + Basic Cardiac Life Support Certification is ... + Flexibility to an occasional evening, night, or weekend. **Licensure** + Minnesota Registered Nurse License is required. + Basic Cardiac Life Support… 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
- Actalent (Rochester, MN)
- …of an accredited baccalaureate nursing program with successful experience as a Registered Nurse and at least one year of RN experience in long-term care. + ... and clinical training programs, and develop policies for risk management systems to protect residents, visitors, and employees. +...MN Registered Nurse license. + Basic Cardiac Life Support Certification (American… 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
- 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