- State of Minnesota (St. Paul, MN)
- **Working Title: Senior Attorney** **Job Class: Staff Attorney 2** **Agency: Human Services Dept** + **Job ID** : 88564 + **Location** : St. Paul + **Telework ... and orders. + Working with the Attorney General's Office on litigation and appeals related to background studies and expungements. + Acting as liaison between… more
- CVS Health (St. Paul, MN)
- …And we do it all with heart, each and every day. **Position Summary** The ** Senior Claims Benefit Specialist** will review and adjust SF ( _self-funded_ ), FI ( ... written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals . + Ensure all compliance requirements are satisfied and that… more
- Cardinal Health (St. Paul, MN)
- …industry including Commercial and Government plans, Prior Authorizations, and Appeals + Experience with Microsoft Office products including Word, PowerPoint, ... Teams, Outlook, and Excel + Excellent observation skills to easily identify trends and problems while providing solutions + Superior written & verbal communication skills + Required to effectively present information in a one-on-one and small group situations… more
- CVS Health (St. Paul, MN)
- …written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Ensures all compliance requirements are satisfied and all ... payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains… more
- Blue KC (Workman, MN)
- …centered medical home, population management, reporting capability, etc. Acts as senior clinical staff person for credentialing or utilization management program, ... for medical, surgical and pharmacy activity. + Participates in medical appeals activity. Reviews all 2nd-level overturned cases related to medical… more
- Evolent (St. Paul, MN)
- …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (St. Paul, MN)
- …(NCQA) guidelines. + Provides clinical rationale for standard and expedited appeals . + Ensures documentation of all communications with medical office staff ... overall accountability for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in… more
- Evolent (St. Paul, MN)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (St. Paul, MN)
- …of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Robert Half Legal (Minneapolis, MN)
- …are partnering with a mid-size Minneapolis law firm in search of a Construction Litigation Senior Associate / Partner. As a key member of the firm, you will work on ... litigation cases, including pre-trial motions, discovery, depositions, trial preparation, and appeals . + Legal Research: Conduct detailed research and analysis of… more