Top 44 Utilization review Jobs in Saint Paul Mn

Registered Nurse
Amivie CustomCare —West Saint Paul, MN
- $48 - $55 an hour
- On call
- Nursing
- Current TB test
- RN License
- Paid holidays
- Health insurance
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
Diagnostic Radiology- Medical Record Reviewer
Dane Street, LLC —Minneapolis, MN
- Remote
- BC/BE
- Senior level
- Radiology
Quick Apply
Clinical Documentation Integrity (CDI) Specialist
Optum —Eden Prairie, MN
- $72,800 - $130,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Hospital
- 5 years
Director of Utilization Management
Blue Cross and Blue Shield of Minnesota —Eagan, MN
- $135,500 - $230,300 a year
- Hybrid work
- Office
- 3 years
- High school diploma or GED
- Health insurance
- Dental insurance
Senior Business Analyst - Utilization Management/Behavioral Health
Blue Cross and Blue Shield of Minnesota —Eagan, MN
- $90,800 - $149,800 a year
- Hybrid work
- Research
- Office
- Analysis skills
- Health insurance
- Dental insurance
8h
Supervisor, Utilization Management
Medica Services Company LLC —Minnetonka, MN
- $78,700 - $134,900 a year
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid holidays
- Health insurance
1d
Case Manager, Behavioral Health
HealthPartners/GHI —Bloomington, MN
- $34.28 - $51.42 an hour
- Full-time
- LMFT
- RN License
- Mid-level
- Health insurance
RN - Admissions Acute
Capitol Park Mental Health Hospital —Saint Paul, MN
- $42.00 - $48.80 an hour
- Full-time
- Acute care
- CPR Certification
- Nursing
- Free parking
- Health insurance
Clinical Solutions Specialist
Medline Industries —Minneapolis, MN
- $79,000 - $119,000 a year
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
- Health insurance
- 401(k)
Autism Care Manager, BCBA Pipeline
HealthPartners/GHI —Bloomington, MN
- $34.28 - $51.42 an hour
- Full-time
- RN License
- Mid-level
- 3 years
- Health insurance
Medical Claims Review Medical Director - Surgeon - Remote
Optum —Eden Prairie, MN
- $248,500 - $373,000 a year
- Full-time
- Remote
- Medicine
- Microsoft Outlook
- Surgery
Quick Apply
5d
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
7d
RN Case Manager
HealthPartners/GHI —Bloomington, MN
- $36.37 - $54.55 an hour
- Full-time
- Nursing
- RN License
- Computer literacy
- Health insurance
Care Coordinator, LSW (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
7d
RN Education Development Specialist, Comprehensive Care Advocacy
HealthPartners/GHI —Bloomington, MN
- $39.73 - $59.59 an hour
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
1d
Supervisor, Behavioral Health Case Management (BCBA)
HealthPartners/GHI —Bloomington, MN
- $38.19 - $59.19 an hour
- Full-time
- RN License
- Mid-level
- Master's degree
- Health insurance
Consultant, Clinical Pharmacy Program
HealthPartners/GHI —Bloomington, MN
- $61.91 - $92.87 an hour
- Full-time
- Research
- Mid-level
- Analysis skills
- Health insurance
SSBV Medical Director - Remote
Optum —Plymouth, MN
- $248,500 - $373,000 a year
- Full-time
- Remote
- Medicine
- BC/BE
- Pass drug screening
Manager, Clinical Pharmacy
Medica Services Company LLC —Minnetonka, MN
- $113,400 - $194,400 a year
- Writing skills
- Office
- Bachelor's degree
- Paid holidays
- Health insurance

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Registered Nurse

Amivie CustomCare
West Saint Paul, MN

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Job Details

$48 - $55 an hour

Benefits

Paid holidays
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Vision insurance

Qualifications

RN License

Full Job Description

Overview:

The Registered Nurse is accountable for ensuring the overall quality and appropriateness of patient care and nursing services for all home care clients as assigned. We are seeking a Registered Nurse to join our team. In this role, you will primarily be creating and managing a plan of care for individual patients. You are a Registered Nurse (RN) who operates with great attention to detail and a big heart. You take pride in creating personalized care plans for patients and are able to observe and communicate effectively in your patient's best interest. To succeed, you should have demonstrated knowledge and skill in current nursing practices as well as a strong penchant for solving problems.

Competitive salaries
Medical, Dental, Vision & supplemental insurance plans
401(k) plan
Paid holidays
Tuition reimbursement

Responsibilities:

Supervision

Utilization of appropriate interpersonal styles and methods in guiding staff members toward company objectives.
Evaluate patients referred for home care to determine appropriateness for admission.
Refer patients needing other resources of care to appropriate services. Consult with family, physicians, institutional staff, clients, nurses, and other disciplines while establishing a coordinated home care plan.
Notify appropriate branch personnel of patient acceptance for home care and provide intake data, essential background information, care plan, and signed physician orders.
Oversee the initial and ongoing assessment of home care clients.
Complete a nursing assessment of all home care clients within 48 hours of order.
Initiate, review, and revise the plan of care.
Obtain a physician's plan of treatment/care and ensure their execution.
Review plan of care every 90 days or more often, if necessary.
Review timesheets bi-weekly and ensure that tasks match the care plan.
Visit all home care clients as required by CBC Home Care to:
Assess the patient's overall health status and home safety environment.
Review and determine that care is provided according to the care plan.
Determine care is appropriate to identify the needs of the patient.
Revise the care plan as needed.
Determine care is being provided on assigned days and time as scheduled.
Determine that staff member is oriented to assigned responsibilities and the patient's individual needs.
Ensure that competency screening is initiated and on-going with supervision.
Review bloodborne pathogens and exposure control with each employee during orientation and review on an annual basis.
Ensure that the client is satisfied with service.
Handle and report problems to appropriate parties.
Confer with agency personnel on client progress and ongoing evaluation.
Evaluate all employees as required by CBC Home Care standards.
Counsel employees as needed.

Operations/Administration:

Coordinating the various aspects of branch operations required to ensure compliance with all federal, state, and local government laws and guidelines as well as CBC Home Care policies and procedures.
Responsible for implementing, maintaining, and following all appropriate standards.
Participate on an assigned advisory board or utilization review committee.
Review all client records every 90 days or more often, if necessary.
QA record checks on 10% of clients' charts of office every quarter per policy.
Verbal or written report to physician as necessary regarding client's response to services.
Secure/coordinate equipment and supplies for the client as needed in the home
Assist staff in determining skills, specialties, and preferences of employees.
Assist with orientation of new employees and review blood borne pathogens, exposure control sections and other pre-competency screenings with each new employee.
Give input and review skill matching of employee's competency to client needs.
On-Call duties

Community/Client Education:

Develop and maintain working relationships with key contacts in health care institutions and community service organizations.
Communicate the concept of quality client care by QHS to associates in various settings.
Provide consultation on discharge from care or re-admission to hospital or other facility.
Provide feedback to facility personnel on referrals.
Serve as a resource to the community on home care issues and practices.
Participate in community outreach and speaking engagements.
Call on physicians, discharge planners, trust officers, case managers, and other contacts on a regular basis to report quality home care services being provided to clients by the agency.
Educate professional and lay individuals about the services QHS provides.
Provide new and/or continued service by cultivating and establishing rapport with

members of the healthcare field.

Planning and Organizing:

Establish a course of action to accomplish specific goals.
Plan proper assignments of personnel and appropriate allocation of resources.
Establishing goals, budgeting, setting priorities, allocating proper amounts of time to activities, and maintaining an awareness of inter-relationships between activities.

Additional Responsibilities:

- Maintain current RN license and required continuing education.
- Obtain annual TB testing/screening and other health exams as required by state regulations.
- Be aware and adhere to all federal and state regulatory standards.
- Adhere to CBC policies and procedures, Code of Ethics, Standards of Practice, and Rights & Responsibilities.
- To ensure the health and safety of individuals.
- Practice safely and competently.
- Any other related responsibilities as deemed appropriate by the supervisor.

Qualifications:

Education/Competency/Work Experience:

Accredited and current RN license.
Bachelor's degree (BSN) or Associate degree (ADN) required.
Home care experience preferred.

Skills/ Experience:

Requires experience as RN in home care setting or direct patient care.

Currently licensed as a Registered Nurse in the state the job is posted with an unencumbered license.
Minimum of three years nursing experience.
Minimum of one year supervisory nursing experience preferred.
Evidence of annual TB tests or screenings and other exams as required by law.
Strong interpersonal skills.
Strong communication and problem-solving abilities.

CBC1

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Refine Your Search

utilization review jobs in saint paul mn

Registered Nurse

SSBV Clinical Claim Review RN

Diagnostic Radiology- Medical Record Reviewer

Clinical Documentation Integrity (CDI) Specialist

Director of Utilization Management

Senior Business Analyst - Utilization Management/Behavioral Health

Supervisor, Utilization Management

Case Manager, Behavioral Health

RN - Admissions Acute

Clinical Solutions Specialist

Autism Care Manager, BCBA Pipeline

Medical Claims Review Medical Director - Surgeon - Remote

Care Coordinator, RN (MSHO)

RN Case Manager

Care Coordinator, LSW (MSHO)

RN Education Development Specialist, Comprehensive Care Advocacy

Supervisor, Behavioral Health Case Management (BCBA)

Consultant, Clinical Pharmacy Program

SSBV Medical Director - Remote

Manager, Clinical Pharmacy

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