- Merck & Co. (Minneapolis, MN)
- …distribution (Oncology group purchasing organizations, wholesalers, and specialty pharmacies). Review and evaluate patterns for products purchased and prescribed ... the in-scope customer team: Customer Team Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more.… more
- Evolent (St. Paul, MN)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Evolent (St. Paul, MN)
- …for the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse , you will be a key member of the utilization ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Adecco US, Inc. (Minneapolis, MN)
- …and clinical criteria, rendering approvals when appropriate. . You will summarize medical information for review by the Medical Director as needed, ... inpatient hospital setting . Experience applying benefits and criteria to clinical reviews . Utilization Management, pre-authorization, concurrent review , or… more
- Fresenius Medical Center (Hastings, MN)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Essentia Health (Duluth, MN)
- **Job Description:** Manages all aspects of conducting clinical trials. As the primary resource for the protocols, the research nurse will act as liaison between ... the investigators, primary care providers, the scientific and institutional review boards, and the sponsor. Along with the investigator, the research nurse will… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, ... Nurse issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
- Humana (St. Paul, MN)
- …guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals....TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements… more
- Fresenius Medical Center (Duluth, MN)
- …to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. + Delivers safe, effective care in a ... May be assigned to in-center patient care on an as needed basis + Review and comply with the Code of Business Conduct and all applicable company policies… more
- Veterans Affairs, Veterans Health Administration (St. Cloud, MN)
- …supports the physical, emotional, and social well-being of Veterans. Serve as the clinical lead of the integrated care team, guiding and coordinating services to ... and community partners to promote seamless, coordinated care. Apply utilization review criteria and evidence-based standards to ensure safe, efficient, and… more
