- 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
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …any legally protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Medical Management Auditor - RN Location: Remote Career Area: ... of auditing and analysis to obtain operational quality within Medical Management for case management ,...other accountabilities as assigned. Required Skills and Experience ⦁ Registered Nurse licensure in MN. ⦁ 3+… 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
- 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
- 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