- Novo Nordisk Inc. (Minneapolis, MN)
- …include key opinion leaders (KOL's), academic institutions, physicians, nurse practitioners, diabetes educators, pharmacists, blood bank staff, organized ... policies, legal, regulatory, and compliance requirements Ensures effective administrative management of regional business as well as operational budgets Maintains… more
- 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
- CVS Health (St. Paul, MN)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation 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
- 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 (Crystal, 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
- 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) ... patient's plan of care and develops, implements, monitors, and documents the utilization of resources and progress of the patient through their care, facilitating… 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)
- …difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and ... and member satisfaction. Required Skills and Experience * Registered nurse or licensed behavioral health clinician (ie LICSW, LPCC,...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… 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
- 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
- Grifols Shared Services North America, Inc (Minneapolis, MN)
- …institutions aligned with customer segmentation and enhance formulary and dosing protocols. * Utilization of Managed Markets, Marketing, Ig Nurse Educators, MSL, ... Centers ie neurology department with residents and fellows, Infusion Suite Nurse , Clinical Pharmacists, DOP for formulary consideration and specialty pharmacy etc.)… 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
- Fairview Health Services (Minneapolis, MN)
- …resource management , quality, regulatory compliance, educational opportunities, and financial management . Serves as a nurse leader and role model to ... according to pre-established parameters. + Responsible for effective fiscal management of assigned area(s) to ensure proper utilization...+ 1 year of leadership experience + MN Registered Nurse (RN) License + Basic Life Support (American Heart… more
