- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CenterWell (St. Paul, MN)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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*0.8 FTE ... *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including patient status, treatment plans, and healthcare… 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...to 5) years of professional leadership experience (ie, charge nurse , team leader, preceptor, committee chair, etc.) * Five… more
- Sharecare (St. Paul, MN)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… 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 ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … 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 ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… more
- Fresenius Medical Center (Shakopee, MN)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… 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
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …bilingual Spanish speaker * 1+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience. * ... across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … experience. * 1+ years of managed care experience, eg case management /health coach, utilization management and/or auditing experience. Compensation ... US Minimum Experience Required 1+ years of managed care experience, eg case management /health coach, utilization management and/or auditing experience. Shift… more
- Datavant (St. Paul, MN)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... 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 versed in… more
- Sharecare (St. Paul, MN)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Grifols Shared Services North America, Inc (Minneapolis, MN)
- …institutions aligned with customer segmentation and enhance formulary and dosing protocols. * Utilization of Managed Markets, Marketing, Ig Nurse Educators, MSL, ... Centers ie neurology department with residents and fellows, Infusion Suite Nurse , Clinical Pharmacists, DOP for formulary consideration and specialty pharmacy etc.)… 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 ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Good Samaritan (Waconia, MN)
- …providers to plan, implement and evaluate care. Includes personal care management , medication administration, care planning, scheduling physician visits, setting up ... in the functions of the applicable technical software setting and process/ utilization improvement. Assists and supports human resources administrative processing and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Skills and Experience * 1+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience. * ... Case Manager is a critical component of BCBSMN Care Management team as the primary clinician providing condition and...care between settings. Required Skills and Experience * Registered Nurse licensure in the state of Minnesota with no… more
- Fairview Health Services (Apple Valley, MN)
- …and protocols. + Actively participates in multidisciplinary team approach to case management + Participates in utilization and quality tools and activities ... **low intensity - phone consultation only with first tier nurse triage** + **Openings:** 1.0 FTE (Full Time) -...when necessary. + Completes medical record and electronic order management (via in basket); and completes cross coverage depending… more
- Veterans Affairs, Veterans Health Administration (Minneapolis, MN)
- …patient any upcoming appointments prior to leaving the clinic area. Ensures utilization of clinic appointments by filling open appointments slots as cancellations ... Participates in team huddles and team meetings where patient care planning and management occur. Assures that all visitors and telephone calls are referred in a… more
- Adecco US, Inc. (Minneapolis, MN)
- …. Experience applying benefits and criteria to clinical reviews . Utilization Management , pre-authorization, concurrent review, or appeals experience **Why ... law; and Holiday pay upon meeting eligibility criteria. **IMPORTANT:** This **Registered Nurse ** role is being recruited for by Adecco's Healthcare & Life Sciences… more