• Utilization Management Review

    Humana (St. Paul, MN)
    …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) with no… more
    Humana (01/20/25)
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  • Utilization Management Spec…

    Fairview Health Services (St. Paul, MN)
    …Job Description** **Job Expectations:** + Perform and document timely and accurate utilization management review to ensure compliance with all ... **Overview** **Fairview Health Services is hiring a casual** ** Utilization Management Spec RN **...**Required** + Bachelor's degree in Nursing + 3-5 years Utilization Review or Case Management more
    Fairview Health Services (01/23/25)
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  • Mgr Utilization Review RN

    Baylor Scott & White Health (St. Paul, MN)
    …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
    Baylor Scott & White Health (01/23/25)
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  • Care Manager RN - Weekends (Remote)

    Highmark Health (St. Paul, MN)
    …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
    Highmark Health (01/07/25)
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  • Prior Authorization Specialist RN PRN

    Intermountain Health (St. Paul, MN)
    …REGISTRATION, LICENSE (*indicates primary source verification requirement) Required: + Active Registered Nurse License Preferred: + Certified Healthcare Access ... Associate (CHAA) EXPERIENCE Required: + Licensed Registered Nurse + Minimum of 2 years'...experience in acute clinical nursing setting + Knowledge of utilization management and case management more
    Intermountain Health (01/18/25)
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  • RN Clinical Consultant, Claims Shared…

    Guardian Life (St. Paul, MN)
    …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
    Guardian Life (12/20/24)
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