- Elevance Health (Mendota Heights, MN)
- RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
- Highmark Health (St. Paul, MN)
- … UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure required. Additional specific state licensure(s) may be required ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services,… more
- CVS Health (St. Paul, MN)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote team. ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We...are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence… more
- CVS Health (St. Paul, MN)
- … Management ( UM ) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... includes reviewing written clinical records. **Key Responsibilities of the UM Nurse Consultant** (Includes but is not...of Healthcare Services and benefit utilization. **Required Qualifications** + Registered Nurse ( RN ) with current… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, ... RN conducts timely reviews of inpatient and outpatient medical records to determine the appropriateness of admissions, continued.../*License/Certifications:*/ * Possession of a valid license as a Registered Nurse issued by the State of… more
- Evolent (St. Paul, MN)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director...care + Minimum of one year of experience with medical management activities in a managed care… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …to improve provider performance and member satisfaction. Required Skills and Experience * Registered nurse with current MN license and no existing or pending ... in utilization management or a related field. * Experience in UM /CM/QA/Managed Care. * Knowledge of state and/or federal regulatory policies and/or provider… more
- Humana (St. Paul, MN)
- …**Required Qualifications** + Bachelor's degree in Nurse (BSN). + Valid and unrestricted Registered Nurse ( RN ) license in the (appropriate state) with no ... achieve desired clinical outcomes and to enhance quality of medical care. The **Telephonic Nurse Case Manager**...behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in… more
- Highmark Health (St. Paul, MN)
- …:** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a ... in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more