- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …Nurse issued by the State of Minnesota. **Title:** * Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* ... **12/2/2025 - REVISED FTE *_SUMMARY:_* We are currently seeking a* Staff Nurse *to join our Utilization ...may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional...utilization and denial management. Liaises with provider office staff and facilitates meetings with payers, as appropriate *… more
- Veterans Affairs, Veterans Health Administration (St. Cloud, MN)
- …internal providers, and community partners to promote seamless, coordinated care. Apply utilization review criteria and evidence-based standards to ensure safe, ... you're administering treatments, developing individualized care plans, mentoring support staff , or guiding patients and families through safe transitions, your… more
- Veterans Affairs, Veterans Health Administration (St. Cloud, MN)
- …from the community. He/she possesses the knowledge related to VHA guidelines, utilization review criteria, current evidence-based standards of care, compliance ... seeking a part-time (20 hrs/week) Urgent Care Advanced Practice Nurse to care for Veterans in St. Cloud, MN....of Authority as established by the facility Chief of Staff . Core elements of performance include knowledge and active… more
- Evolent (St. Paul, MN)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Mille Lacs Health System (Onamia, MN)
- …with clinic patients and their family/caregiver(s), clinic/hospital/specialty providers and staff , and community resources. The Clinic RN collaboratively assists ... at the end of the bullet point. + Perform Nurse visits* Facilitate process and work flows to augment...(meaningful use, PCRS, MN community measures)* + Assist clinic staff and providers to enable efficient flow of patient… more
- Prime Therapeutics (St. Paul, MN)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... of pharmacy with us. **Job Posting Title** Infusion Referral Nurse Sr- REMOTE **Job Description** Under supervision, is responsible...both the member and the ordering physician (or office staff ) and to agree to find a lower cost… more
- Evolent (St. Paul, MN)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Evolent (St. Paul, MN)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and ... assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief… more
- Fresenius Medical Center (Roseville, MN)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
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