- Humana (St. Paul, MN)
- …ad hoc reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, Durable ... caring community and help us put health first** The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 … more
- Prime Therapeutics (St. Paul, MN)
- …company achieving revenue goals and operational objectives. Responsible for executing utilization management programs on behalf of health plan/payor customers, ... clinical reviewer. + Practices and maintains the principles of utilization management by adhering to the company...cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization … more
- Elevance Health (Mendota Heights, MN)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and procedures. + Investigates potential… more
- Bluestone Physician Services (Woodbury, MN)
- …medical care teams to ensure health care quality measures are met and use utilization management tools to meet value-based goals + Supporting members during ... and follow up plan Qualifications : Education/Certification/Experience + Current Minnesota Registered Nurse license + One or more years of experience working with… more