- 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
- 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 (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
- 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
- Intermountain Health (St. Paul, MN)
- …+ Care Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. + Bi-Lingual/Spanish Speaking ... The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves… 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
- 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 (Woodbury, MN)
- …in promoting the practice of professional nursing as well as the development and utilization of resources. The PCS works cooperatively with the Nurse Manager, ... people we serve. The PCS participates in aspects of budgeting, performance management and human resources matters, including recruitment and the administration of… more
- Fairview Health Services (Cottage Grove, MN)
- …and protocols. + Actively participates in multidisciplinary team approach to case management + Participates in utilization and quality tools and activities ... Frequency:** **1:3** **low intensity - phone consultation only with first tier nurse triage** + **Fully integrated** Electronic Medical Record (EPIC). + Examines,… more
- Fairview Health Services (Cottage Grove, MN)
- …and protocols. + Actively participates in multidisciplinary team approach to case management + Participates in utilization and quality tools and activities ... Frequency:** **1:3** **low intensity - phone consultation only with first tier nurse triage** + **Fully integrated** Electronic Medical Record (EPIC). + Examines,… more
- Oracle (St. Paul, MN)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more
- Fairview Health Services (Apple Valley, MN)
- …and protocols. + Actively participates in multidisciplinary team approach to case management + Participates in utilization and quality tools and activities ... **low intensity - phone consultation only with first tier nurse triage** + **Openings:** 1.0 FTE (Full Time) -...when necessary. + Completes medical record and electronic order management (via in basket); and completes cross coverage depending… more