- Humana (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records… more
- Adecco US, Inc. (Minneapolis, MN)
- Adecco Healthcare & Life Sciences is hiring remote RN Appeals Reviewers! This role is remote / work from home. Please read below and apply with an updated resume for ... days **Pay:** $40.50 to $42.50 an hour **Responsibilities of the RN Appeals Reviewer:** . Responsible for conducting thorough reviews of member and provider… more
- 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 / This ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …of this position:*The Contract Variance Analyst provides foundational support in managing appeals related to payer contract variances and fatal denials. This role is ... Contract Variance Appeal process by assisting with intake, documentation, and tracking of appeals submitted to third-party payers * Prepares and submits appeals … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …position:*The Contract Variance Analyst Senior is responsible for leading the end-to-end appeals process related to contract variances and fatal denials. This role ... Variance Appeal process, overseeing intake, documentation, and strategic tracking of appeals submitted to third-party payers * Manages and executes high-impact … more
- Presbyterian Homes and Services (Roseville, MN)
- …and managing MDS nurses + Auditing RUG grouper/MDS end splits + Reviewing all expedited appeals and ALJ level appeals + Monthly QI/QM review for assigned region ... at IDT + Site specific education + Key measure management Qualifications + Registered nurse with current licensure from the State Board of Nursing in the state(s) in… 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
- CVS Health (St. Paul, MN)
- …accordance with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... incoming correspondence and internal referrals. + Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs… 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
- 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