- Fresenius Medical Care (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 years business… 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
- CVS Health (St. Paul, MN)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… 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
- CVS Health (St. Paul, MN)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… 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
- 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
- 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
- CVS Health (St. Paul, MN)
- …toward desired outcomes through assessment and evaluation. **Required Qualifications** + Active Registered Nurse Compact License + Minimum 3+ years clinical ... CM, discharge planning and/or home health care coordination experience + Previous Utilization Management experience, transitions of care and discharge planning… 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
- 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
- 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
- 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
- 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
- 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
- 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
