- Fresenius Medical Care (Shakopee, MN)
- About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- CVS Health (St. Paul, MN)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (St. Paul, MN)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … 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 ... utilization and controlling costs./**/ *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including… more
- CVS Health (St. Paul, MN)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …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 role modeling. Functions as the internal...fiscal, legal, compliance, coding, and billing staff to answer clinical questions related to medical necessity and patient status… more
- Evolent (St. Paul, MN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Fresenius Medical Center (Shakopee, MN)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Sharecare (St. Paul, MN)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (St. Paul, MN)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Highmark Health (St. Paul, MN)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Fairview Health Services (Crystal, 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
- CVS Health (St. Paul, MN)
- …CM, discharge planning and/or home health care coordination experience + Previous Utilization Management experience, transitions of care and discharge planning ... Services and strategies, policies and programs are comprised of network management , clinical coverage, and policies. **Position Summary/Mission** Community Care… more
- Good Samaritan (Inver Grove Heights, MN)
- …team. Seeks to evaluate outcomes based on an integration among established clinical , financial and utilization data. Functions in structured and unstructured ... week MDS Coordinator will be a part of our management team. Primary responsibilities will be MDS duties for...rotation shared with the other supervisory staff. MN Registered Nurse , RN required. Prior MDS experience preferred. $15,000 Bonus… 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 ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Skills and Experiences * 2+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience (may be ... outreaches to the member, family and providers to engage in complex case management program. * Conducts clinical assessments with members and providers utilizing… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …, and business case consultant for leadership as they relate to case/disease/ utilization management . * Coordinates the development, revision and implementation ... and cost control. Required Skills and Experience * Registered nurse or licensed behavioral health clinician (ie, LICSW, LPCC,...within insurance or health care setting in case/disease or utilization management * Bachelor's or Master's degree… 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) **Benefit ... inpatient peds units at Masonic Children's Hospital. The Patient Care Management Coordinator provides comprehensive care coordination of patients as assigned. The… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and ... code and modifier code reviews. Your Responsibilities * Applies clinical experience, health plan benefit structure and claims payment...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… more
- Highmark Health (St. Paul, MN)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including review… more
