- 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
- 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 ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Fairview Health Services (Maplewood, 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
- Evolent (St. Paul, MN)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Fresenius Medical Center (Hastings, 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
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Skills and Experience * 2+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience (may be ... Cross and Blue Shield of Minnesota Position Title: RN Specialist Complex Case Management - Transplant Location: Remote Career Area: Health Services About Blue Cross… 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
- 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
- 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 ... members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention… 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
- 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
- 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...Minimum Education Required Required Skills and Experience * Registered nurse with current MN license and with no restrictions… more
- Fairview Health Services (Woodbury, MN)
- …in promoting the practice of professional nursing as well as the development and utilization of resources. The PCS works cooperatively with the Nurse Manager, ... people we serve. The PCS participates in aspects of budgeting, performance management and human resources matters, including recruitment and the administration of… 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 ... Disorders is a critical component of the BCBSMN Care Management team. Behavioral Health Care Advisors will provide clinical...engage with members. Required Skills and Experience * Registered nurse with current MN license and with no restrictions… 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
- Fairview Health Services (Cottage Grove, MN)
- …and protocols. + Actively participates in multidisciplinary team approach to case management + Participates in utilization and quality tools and activities ... Frequency:** **1:3** **low intensity - phone consultation only with first tier nurse triage** + **Fully integrated** Electronic Medical Record (EPIC). + Examines,… more
- Fairview Health Services (Cottage Grove, MN)
- …and protocols. + Actively participates in multidisciplinary team approach to case management + Participates in utilization and quality tools and activities ... Frequency:** **1:3** **low intensity - phone consultation only with first tier nurse triage** + **Fully integrated** Electronic Medical Record (EPIC). + Examines,… more
- Bluestone Physician Services (Eagan, MN)
- …their unique needs. Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage ... to the emergency departments as to acute settings with the goal of reducing utilization and unnecessary costs + Work to increase coordination of care for a vastly… more
- Oracle (St. Paul, MN)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more