- Evolent (St. Paul, MN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (St. Paul, MN)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department in a*/*FLOAT*/*/assignment to support Inpatient, Psych and the ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Fairview Health Services (St. Paul, MN)
- …analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a working knowledge ... research and timely and accurate actions including preparing and submitting appropriate appeals or re-billing of claims to resolve coding denials to ensure… more
- Sharecare (St. Paul, MN)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …* Identifies opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health ... of the department. * Guides member through the Prior Authorization and Appeals process. * Engage providers telephonically in reviewing and understanding treatment… more