- Evolent (St. Paul, MN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (St. Paul, MN)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... + Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… 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 / This ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …of this position:*The Contract Variance Analyst provides foundational support in managing appeals related to payer contract variances and fatal denials. This role is ... Contract Variance Appeal process by assisting with intake, documentation, and tracking of appeals submitted to third-party payers * Prepares and submits appeals … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …position:*The Contract Variance Analyst Senior is responsible for leading the end-to-end appeals process related to contract variances and fatal denials. This role ... Variance Appeal process, overseeing intake, documentation, and strategic tracking of appeals submitted to third-party payers * Manages and executes high-impact … more
- Sharecare (St. Paul, MN)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Fairview Health Services (St. Paul, MN)
- …analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a working knowledge ... research and timely and accurate actions including preparing and submitting appropriate appeals or re-billing of claims to resolve coding denials to ensure… more
- Presbyterian Homes and Services (Roseville, MN)
- …and managing MDS nurses + Auditing RUG grouper/MDS end splits + Reviewing all expedited appeals and ALJ level appeals + Monthly QI/QM review for assigned region ... at IDT + Site specific education + Key measure management Qualifications + Registered nurse with current licensure from the State Board of Nursing in the state(s) in… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …* Identifies opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health ... of the department. * Guides member through the Prior Authorization and Appeals process. * Engage providers telephonically in reviewing and understanding treatment… more
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