- Humana (St. Paul, MN)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (St. Paul, MN)
- …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
- CVS Health (St. Paul, MN)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in CST zones.… more
- Humana (St. Paul, MN)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (St. Paul, MN)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… 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 ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Sharecare (St. Paul, MN)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… 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 ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … 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
- 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
- United Therapeutics (St. Paul, MN)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… 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 or MTN) ... **Job Overview** This Patient Care Management Coordinator provides comprehensive care coordination of patients...of care and develops, implements, monitors, and documents the utilization of resources and progress of the patient through… more
- Fairview Health Services (Minneapolis, MN)
- …services, bringing the very newest ideas in patient care. The Patient Care Management Coordinator will be working on the Acute Rehab Center and the Transitional ... is eligible for benefits. **About this Position:** This Patient Care Management Coordinator provides comprehensive care coordination of patients as assigned. The… more
- Humana (St. Paul, MN)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- Select Medical (Golden Valley, MN)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Teen and Family Case Management Assistant*to join our Aqui Para Ti team. This part-time role will work 40 hours within a two ... delivery of cost-effective health care and identify the appropriate utilization of resources. Coaches patients and parents/caregivers in developmentally appropriate… more
- Bluestone Physician Services (St. Paul, MN)
- …with primary care teams to ensure high quality team-based care + Use utilization management tools to facilitate appropriate transitional care management ... as to acute settings with the goal of reducing utilization and unnecessary costs + Work to increase coordination...Nurse + 3-5 years of experience in case/care management or care coordination + Experience working directly with… more
- Fairview Health Services (Minneapolis, MN)
- …productivity and overall performance. **Responsibilities** + Implementation and ongoing management of the following: Pertinent policies , performance targets ... the needs of the local community. Includes monitoring of current capacity and utilization + Maintains knowledge of and complies with all relevant laws, regulations,… more
- Presbyterian Homes and Services (Roseville, MN)
- …development and management for your assigned region. Qualifications + Registered nurse with current licensure the State Board of Nursing in state(s) in which ... of the RAI process + Experience with MDS completion, reimbursement, clinical resource utilization and/or case management + Ability to work flexible work hours… more
- Fairview Health Services (Minneapolis, MN)
- …and resources. + Serves as liaison with physicians to implement medical management of condition changes, diagnostic test results, lab results, based on knowledge ... and age specific competencies + Provides patient, MD, community and professional nurse education. + Coordinates and participates in patient, staff, MD and community… more