- CVS Health (St. Paul, MN)
- …all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- CVS Health (St. Paul, MN)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (St. Paul, MN)
- …(UM) Nurse Consultant . As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, document and communicate all ... clinical records. **Key Responsibilities of the UM Nurse Consultant ** (Includes but is not limited to) + Reviews...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Cross and Blue Shield of Minnesota Position Title: Principal Provider Performance Clinical Consultant Location: Hybrid | Eagan, Minnesota Career Area: Strategic ... and leading consultative conversations with provider groups about opportunities to improve clinical and cost/ utilization trend. * Responsible for developing and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and leading consultative conversations with provider groups about opportunities to improve clinical and cost/ utilization trend. * Responsible for developing and ... all lines of business. The role works in tandem with the Manager of Clinical Consultation, Pr Provider Performance Clinical Consultants, and the Medical Director… more
- Highmark Health (St. Paul, MN)
- …**Job Description :** **JOB SUMMARY** Dynamic and results-oriented Pharmacy Benefit Consultant , serving as the client-facing expert, driving growth and retention of ... Consultation: Provide in-depth pharmacy benefit expertise, offering strategic guidance, clinical recommendations, and solutions tailored to individual client needs.… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …* Acts as a clinical , care management , and business case consultant for leadership as they relate to case/disease/ utilization management . * ... * Demonstrated skill and experience in developing highly effective clinical teams * Strong leadership ability, proven skills in...within insurance or health care setting in case/disease or utilization management * Bachelor's or Master's degree… 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 ... Services and strategies, policies and programs are comprised of network management , clinical coverage, and policies. **Position Summary/Mission** Community Care… more
- CVS Health (St. Paul, MN)
- …understand trends, and provide clients with recommendations on formulary and utilization management strategies. You will establish relationships both internally ... our custom formulary clients. CFC consultants leverage financial and clinical acumen to assist clients with custom formulary decisions....and externally, and articulate potential management strategies with a deep understanding of the rebate… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …This individual pulls and synthesizes data across multiple domains, including utilization management , prior authorization, claims, denials, and appeals. Their ... focus in the department include but are not limited to provider, health management , quality, product development and client/member analytics. A typical day for the… more