Top 25 Utilization review nurse Jobs in Bloomington, Mn

IBR Clinical Review RN
Optum —Plymouth, MN
- $29 - $52 an hour
- Full-time
- Remote
- Nursing
- RN License
- Pass drug screening
- AD&D insurance
- Employee stock purchase plan
4d
SSBV Clinical Claim Review RN
Optum —Plymouth, MN
- $28.94 - $51.83 an hour
- Full-time
- Remote
- Nursing
- RN License
- Pass drug screening
- AD&D insurance
- Employee stock purchase plan
Utilization Management RN
North Memorial Healthcare —Robbinsdale, MN
- $39.83 - $59.74 an hour
- 8 hour shift
- Hybrid work
- Nursing
- RN License
- Mid-level
- Health insurance
- Tuition reimbursement
RN Case Manager
HealthPartners/GHI —Bloomington, MN
- $36.37 - $54.55 an hour
- Full-time
- Nursing
- RN License
- Computer literacy
- Health insurance
RN Education Development Specialist, Comprehensive Care Advocacy
HealthPartners/GHI —Bloomington, MN
- $39.73 - $59.59 an hour
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
6d
Clinical Risk Nurse
TPAC Underwriters —Blaine, MN
- $90,000 - $120,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
3d
RN Case Manager
North Memorial Healthcare —Robbinsdale, MN
- $37.49 - $56.23 an hour
- 8 hour shift
- Nursing
- RN License
- Mid-level
- Health insurance
- Tuition reimbursement
Clinical Solutions Specialist
Medline Industries —Minneapolis, MN
- $79,000 - $119,000 a year
- Full-time
- Nursing
- Microsoft Excel
- Bachelor of Science
- Health insurance
- 401(k)
Supervisor, Clinical Quality Review
Medica Services Company LLC —Minnetonka, MN
- $78,700 - $134,900 a year
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Health insurance
Care Coordinator, RN (MSHO)
Bluestone Physician Services —Mendota Heights, MN
- $65,000 - $75,000 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Experience working with individuals with disabilities
- Mileage reimbursement
- Health savings account
Quick Apply
12d
Care Coordinator, LSW (MSHO)
Bluestone Physician Services —Golden Valley, MN
- $65,000 - $75,000 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Experience working with individuals with disabilities
- Mileage reimbursement
- Health savings account
Quick Apply

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SSBV Clinical Claim Review RN
Optum —Plymouth, MN
Current and unrestricted RN license in the state of residency. A background in utilization review for an insurance company or experience in case management.
$28.94 - $51.83 an hour
Utilization Management RN
North Memorial Healthcare —Robbinsdale, MN
They work with the medical and care teams (nursing, social services, therapies, and ancillary departments) to ensure the customer is receiving the right care,…
$39.83 - $59.74 an hour

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Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
Quick Apply
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
11d

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IBR Clinical Review RN

Optum -
Plymouth, MN

Apply Now

Job Details

Full-time
$29 - $52 an hour
4 days ago

Benefits

AD&D insurance
Employee stock purchase plan
Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
Employee discount
Referral program
Pet insurance

Qualifications

Research
Acute care experience
Associate's degree

Full Job Description

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Review Clinician serves as a subject matter expert for itemized bill reviews and analyzing hospital facility bills. The clinical reviewer is responsible for documenting, researching and identifying adjustments for payment as part of a team that contributes to the preparation of Forensic Reviews for specific clients.

Employees in this position receive limited supervision within a broad framework of policies and procedures. Employees in this position possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable processes, procedures and billing guidelines.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
Claim Review:

Conduct Forensic Reviews using independent clinical knowledge to compare and analyze charge details of various amounts of total billed charges to determine benefit of full clinical review and estimation of adjustments for the purpose of meeting Optum's core business operations
Complete analysis of billing and departmental guidelines
Participate as needed in the achievement and completion of department goals
Complete focused review of medical records to evaluate clinical course of care as applicable
Assists with resolution of claims as needed to support negotiations and appeals process
Interacts with internal business partners as requested
Maintains appropriate documentation on all claims according to departmental guidelines and procedures
Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work

Other: Research and Special Projects:

Perform research to support audit adjustments and resolve issues
Research reference materials for clinical standards as appropriate
Perform research to identify new adjustments and business rules for the goal of meeting core business operations
Review and respond to research inquiries from team members and complete special research projects
Participate in department and company meetings as requested

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Associate's degree
Active and unrestricted RN license OR LPN in the state of residence
2+ years of clinical experience within an acute care setting
1+ years of experience working with bill review

Preferred Qualifications:

Auditing and coding certifications
Experience working with medical terminology and coding
Experience working with billing, charge master and compliance
Experience working with plan benefit language, CMS (Medicaid and Medicare) and UB 04 billing guidelines
Experience with Microsoft Excel (create, data entry, save)
Strong written and verbal communication skills
Strong organizational and critical thinking skills
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN

Apply Now

Refine Your Search

utilization review nurse jobs in bloomington, mn

IBR Clinical Review RN

SSBV Clinical Claim Review RN

Utilization Management RN

RN Case Manager

RN Education Development Specialist, Comprehensive Care Advocacy

Clinical Risk Nurse

RN Case Manager

Clinical Solutions Specialist

Supervisor, Clinical Quality Review

Care Coordinator, RN (MSHO)

Care Coordinator, LSW (MSHO)

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