- Elevance Health (Mendota Heights, MN)
- RN - Utilization / Medical Management Nurse / InPatient (JR171072) **Work Hours** : 8 hour shift within 8am - 6pm PST. Rotating Weekends and holidays. ... 8am - 6pm PST. Rotating Weekends and holidays. The ** Medical Management Nurse ** is responsible...an equivalent background. + Current active, valid and **unrestricted RN license** to practice as a health professional within… more
- Healthfirst (MN)
- …Services (CMS) or New York State Department of Health (NYSDOH) regulations governing medical management in managed care** + **Relevant clinical work experience** ... team in order to maximize HF member care quality while achieving effective medical cost management ** + **Assists in identifying opportunities for and… more
- Blue KC (Workman, MN)
- …and state and federal regulations. + Valid and active Registered nurse ( RN ) in Missouri and Kansas. + Case Management Certification within 3 years of ... medical policy. Opens case and follows NCQA case management standards. Documents transplant authorization, issues authorization letters, and... and clinical transplant experience + Valid and active Registered nurse ( RN ) licensure in… more
- Highmark Health (St. Paul, MN)
- … UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure required. Additional specific state licensure(s) may be required ... **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services,… more
- CVS Health (St. Paul, MN)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote team. ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We...are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, ... RN conducts timely reviews of inpatient and outpatient medical records to determine the appropriateness of admissions, continued.../*License/Certifications:*/ * Possession of a valid license as a Registered Nurse issued by the State of… more
- Blue KC (Workman, MN)
- …financial assistance** **Employee discount program** **Job Description Summary:** The Medical Policy Nurse Specialist researches, coordinates, analyzes, and ... provides clinical expertise in the application of medical policy and clinical UM guidelines ensuring...+ 5 years of related experience in research, Utilization Management , and medical policy work + Strong… more
- Evolent (St. Paul, MN)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director...care + Minimum of one year of experience with medical management activities in a managed care… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …to improve provider performance and member satisfaction. Required Skills and Experience * Registered nurse with current MN license and no existing or pending ... in utilization management or a related field. * Experience in UM /CM/QA/Managed Care. * Knowledge of state and/or federal regulatory policies and/or provider… more
- Humana (St. Paul, MN)
- …**Required Qualifications** + Bachelor's degree in Nurse (BSN). + Valid and unrestricted Registered Nurse ( RN ) license in the (appropriate state) with no ... achieve desired clinical outcomes and to enhance quality of medical care. The **Telephonic Nurse Case Manager**...behavioral health spectrum. They will also coordinate with other Medical Management programs (DM/PN) as needed, in… more
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