- Humana (St. Paul, MN)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (St. Paul, MN)
- …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
- CVS Health (St. Paul, MN)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in CST zones.… more
- Humana (St. Paul, MN)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (St. Paul, MN)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Evolent (Workman, MN)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Sharecare (St. Paul, MN)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Indian Health Service (Red Lake, MN)
- Summary This position is a Supervisory Nurse (Inpatient) located at the PHS Hospital Facility in Red Lake, MN. The Clinic and Emergency Room provide ambulatory ... qualities improved plans, methods, procedures, documentation, and follow-up with maximum utilization of staff and resources. Maintains current inpatient care manuals… more
- Highmark Health (St. Paul, MN)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Fairview Health Services (Minneapolis, MN)
- …for services provided . Completes the requirements of various payers and utilization management reviewers to obtain authorization for treatment. Demonstrates the ... as an interdisciplinary team member. Responsible, as assigned, for the management of caseload. Job Expectations: Works collaboratively with the physician and… more