- Actalent (Minnetonka, MN)
- Utilization Management Nurse Job Description As a Utilization Management Nurse for Post Acute care, you will be responsible for reviewing and ... the medical necessity of post-acute stays. Essential Skills + Expertise in utilization management and utilization review. + Experience in acute care and… more
- 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
- 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 / ... *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including patient status, treatment plans, and healthcare… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. 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...to 5) years of professional leadership experience (ie, charge nurse , team leader, preceptor, committee chair, etc.) * Five… more
- Veterans Affairs, Veterans Health Administration (St. Cloud, MN)
- …providers, and community partners to promote seamless, coordinated care. Apply utilization review criteria and evidence-based standards to ensure safe, efficient, ... and high-quality outcomes. Identify Veterans requiring disease management and connect them to appropriate internal or external resources. Communicate effectively… more
- Fairview Health Services (Princeton, 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
- Actalent (Rochester, MN)
- Infection Preventionist / Quality Assurance Nurse Job Description The Infection Preventionist/Quality Assurance (IP/QA) nurse collaborates with leadership to ... educational and clinical training programs, and develop policies for risk management systems to protect residents, visitors, and employees. + Incorporate computer… 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
- Mayo Clinic (Rochester, MN)
- …a dedicated professional to join our team as Infection Preventionist/Quality Assurance (IPQA) Nurse . As IPQA Nurse , you will be collaborating with leadership to ... educational and clinical training programs. + Developing policies for risk management systems to protect residents, visitors, and employees. + Computer hardware,… more
- Intermountain Health (St. Paul, MN)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Mille Lacs Health System (Onamia, MN)
- …with an asterisk (*) at the end of the bullet point. + Perform Nurse visits* Facilitate process and work flows to augment quality initiatives (meaningful use, PCRS, ... (eg medications, medical equipment, home care etc.)* + Assist in development and management of anticoagulant program (TBD) + Create and promote adherence to a care… more
- Mille Lacs Health System (Onamia, MN)
- …comprehensive patient and family health education.* + Monitors and enforces utilization of proper nursing techniques and procedures.* + Enacts the counseling ... role of the nurse . + Attends multi-disciplinary treatment staffing's. + Attends monthly...expected to report unsafe conditions to a member of management . Required Education and Experience + Graduate of accredited… more
- Mayo Clinic (Rochester, MN)
- …and weekends based on workload demand. On call required.** The Occupational Health Nurse (OHN) role centers on the prevention of adverse health effects from ... for exposure, evaluating education and training programs, providing case management to employees off of work or with restrictions...they can safely return to work. The occupational health nurse strives to ensure that all health and safety… more
- Aspirus Ironwood Hospital (Duluth, MN)
- …ensuring implementation and monitoring of compliant documentation strategies and utilization management principles. MINIMUM QUALIFICATIONS + Education: Graduate ... LUKE'S HOSPITAL in Duluth, MN is seeking a REGISTERED NURSE - ACUTE CARE COORDINATOR to join our CARE...Current license in Minnesota to practice as a Registered Nurse . Wisconsin Background Study upon hire and renewed per… more
- Humana (St. Paul, MN)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals... 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require… more
- Mayo Clinic (Rochester, MN)
- …multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization Review, including concurrent admission status and continued stay clinical ... terminology and disease processes. Knowledge of CPT coding, resource management systems, electronic medical record and personal computers beneficial. Demonstrated… 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
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Teen and Family Case Management Assistant*to join our Aqui Para Ti team. This part-time role will work 40 hours within a two ... delivery of cost-effective health care and identify the appropriate utilization of resources. Coaches patients and parents/caregivers in developmentally appropriate… 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, ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more