- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- **12/2/2025 - REVISED FTE *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / ... utilization and controlling costs./**/ *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including… 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 Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (Hastings, 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
- Elevance Health (Mendota Heights, MN)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Location:** This role enables associates...required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines is preferred + ICD-9… 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
- 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)
- …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
- Elevance Health (Mendota Heights, MN)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- CenterWell (Brooklyn Park, MN)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... to sit on-site at our** **Brooklyn Park, MN** **branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by… more
- CVS Health (St. Paul, MN)
- …- 3+ years of acute experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience using MS Office suites - Must be ... of high performing teams. Works closely with functional area management to ensure consistency in clinical interventions...Occasional travel less than 5% to complete audits/meetings - Utilization Management is a 24/7 operation and… more
- Philips (Minneapolis, MN)
- …etc) with clinical experience as Radiologic Technologist (RT) or Registered Nurse (RN) highly preferred. + Experience in healthcare (in the hospital) within ... **Sales Support, Clinical Specialist - FORS (West/National Travel)** In this...to effectively manage assigned accounts in terms of driving utilization , customer relationship management , problem resolution, etc.… 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
- Fairview Health Services (Minneapolis, MN)
- …+ 1 year RN experience + Registered Nurse **Preferred Qualifications** + Case Management Nurse + Basic Life Support (American Heart Assoc, Red Cross or MTN) ... of care and develops, implements, monitors, and documents the utilization of resources and progress of the patient through...requirements. This position is accountable for the quality of clinical services delivered by both them and others and… 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 ... 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)
- …the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and tools. ... opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with...* 1+ years of managed care experience; eg case management /health coach, utilization management and/or… more
- Grifols Shared Services North America, Inc (Minneapolis, MN)
- …Academic Centers ie neurology department with residents and fellows, Infusion Suite Nurse , Clinical Pharmacists, DOP for formulary consideration and specialty ... institutions aligned with customer segmentation and enhance formulary and dosing protocols. * Utilization of Managed Markets, Marketing, Ig Nurse Educators, MSL,… more
- Novo Nordisk (Minneapolis, MN)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... The Position Territory: (IA, MN, WI) Builds relationships and demonstrates the clinical outcome and benefits of NNI products. Educates and demonstrates the benefits… 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
- Oracle (St. Paul, MN)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more