20 Best Registered Nurse jobs in Maple Grove, MN (Hiring Now!)

RN Nurse Reviewer - Remote
UnitedHealth Group —Eden Prairie, MN
Identify any cases that are at high-risk for complex discharge planning or case/risk management intervention and make appropriate referrals.
$58,300 - $114,300 a year
6h
Registereed Nurse/ RN - Clinic/ Family Practice
Fairview Health Services —Brooklyn Park, MN
The nurse may connect with patients, and the public, to educate them about various medical conditions. The registered nurse(RN)is responsible for planning,…
Estimated: $66.1K - $83.7K a year
1d
Nurse Clinician - Gamma Knife
Fairview Health Services —Minneapolis, MN
Uses information technology and research methods appropriately to: inform and guide the design of databases that generate meaningful evidence, analyze data,…
From $46.25 an hour
Registered Nurse/RN - Clinic
Fairview Health Services —Elk River, MN
The nurse will educate patients and the public about various medical conditions, maintain complete, timely and accurate clinical documentation for each patient…
Estimated: $64.4K - $81.5K a year
4d
Part-Time Home Health Nurse - Minimum 2 Days Per Week!
Legacy Home Care —Maple Plain, MN
Possess a current Registered Nurse license in the State of Minnesota. Mileage and cell phone reimbursement. All of our clinicians work in strategic "territories…
Estimated: $102K - $129K a year
Quick Apply
3d
Part Time Utilization Management Specialist - Remote near Minneapolis, MN
Optum —Minneapolis, MN
Evaluates potential denials or payment issues and initiates communication with physician or clinician regarding next steps. Bachelor’s degree in nursing.
Estimated: $77.7K - $98.4K a year
2d
Registered Nurse - Social Service Organization
Meridian Services, Zenith Services & Orion Associates —Golden Valley, MN
Approachable demeanor with ability to answer medical related questions from staff, while providing a teaching approach through the communication.
$90,000 a year
Quick Apply
1d
Registered Nurse (RN)
Med Studio —Minnetonka, MN
You will experience & learn things, do things, and make decisions on things that no big stuffy healthcare company would ever allow you to do (of course - within…
From $40 an hour
Quick Apply
4d
RN, OB/GYN
KHR —Minneapolis, MN
Collaborate with physicians and multidisciplinary teams to develop individualized care plans. Monitor and assess patients' conditions.
$35 - $42 an hour
Quick Apply
5d
Registered Nurse (RN) - Pediatric Emergency Department
Fairview Health Services —Minneapolis, MN
The registered nurse in the Emergency Department is responsible and accountable for patient assessment, analysis, nursing diagnosis, planning, intervention…
Estimated: $74K - $93.7K a year
3d
RN/LPN
Enriching Home Care Services, LLC —Plymouth, MN
A valid Minnesota driver's license with a good driving record is mandatory. Current nursing license in the state of MN.
$27 - $29 an hour
Quick Apply
5h
Registered Nurse - RN
Ebenezer —Minnetonka, MN
Current MN RN license or by start date. Monitors work and performance of licensed and unlicensed staff. Maintains current assessment and documentation using…
$47 an hour
Interim Nurse Consultant
Pathway Health —Minneapolis, MN
Must have a current RN license in state. Maintain current working knowledge of applicable state and federal standards, regulations and industry standards of…
$45 - $50 an hour
Quick Apply
Clinic RN
KHR —Minneapolis, MN
Previous asthma care, OB or supervisor RN experience is required. Monday-Friday, 8:30 a.m. to 5 p.m. (no weekends).
$38 - $42 an hour
Quick Apply
5d
RN Triage Nurse
Stellis Health, P.A. —Buffalo, MN
Triage incoming patient phone calls. Current Minnesota RN license required. Serve as resource to clinical staff regarding medical information and patient…
Estimated: $66.2K - $83.8K a year
Quick Apply
RN/QUALIFIED PROFESSIONAL (QP)20-40 hours per month
A+ Home Care —Bloomington, MN
Work 20-40 hours per month flexibly from home and in client homes providing training, supervision, and evaluation of PCAs, and overseeing the delivery and…
$42 - $44 an hour
Quick Apply
1d
Staff Nurse RN (0.8 FTE) - Brooklyn Park Clinic
Hennepin Healthcare —Brooklyn Park, MN
Possession of a valid license as a Registered Nurse issued by the State of Minnesota. Within the context of the Hennepin Healthcare System Relationship-Based…
Estimated: $60K - $76K a year
5d
Clinic RN
Summit Orthopedics —Vadnais Heights, MN
Must be able to travel to outreach clinic sites with physician and be flexible with schedule. Conduct phone assessment of patient needs as indicated.
Estimated: $75.7K - $95.9K a year
Quick Apply
Registered Nurse/Licensed Practical Nurse
TRUSTWORTHY HOME HEALTH CARE —Brooklyn Park, MN
Accurately delivered a complete range of nursing services like obtaining and documenting patients/residents’ history and medication lists to assess individual…
$42 - $46 an hour
Quick Apply
Registered Nurse - Endoscopy
Methodist Hospital —Saint Louis Park, MN
Experience in the following areas is preferred: Endoscopy procedures, ACLS certification, IV insertion skills, and administration of moderate sedation.
Estimated: $88.7K - $112K a year

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RN Nurse Reviewer - Remote

UnitedHealth Group - Eden Prairie, MN

Apply Now

Job Details

Full-time $58,300 - $114,300 a year 6 hours ago

Benefits

401(k) matching

Qualifications

NICU experience
RN License
Surgery
Case management
Utilization management
Bachelor of Science in Nursing
Discharge planning
Organizational skills
Certified Case Manager
2 years
Communication skills
Compact State Nurse License

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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Position in this function provides efficient, effective risk management according to each specific benefit plan for PreferredOne products, using utilization review.

You will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

Utilize the Preferred One medical criteria and those of other regulatory bodies, (i.e. NCQA, DOH), the exempt and focused review programs, and the patient’s benefit plan summary to perform medical necessity, level of service and appropriateness review
Perform inpatient and outpatient pre-admission, concurrent review and decision support based on medical necessity, appropriateness of treatment setting and length of stay utilizing Preferred One criteria and/or community standards and professional judgments
Document timely and concise information which clearly outlines the utilization review strategy online
Accurately apply benefit language to each review situation
Identify any cases that are at high-risk for complex discharge planning or case/risk management intervention and make appropriate referrals
Perform utilization reviews for complex medical conditions such as Transplants and NICU inpatient to meet the needs of internal and external customers
Perform utilization reviews and assist with Transition of Care and Extended Hour Nursing to meet the needs of internal and external customers
Perform Pre-Service and Post-Service Appeal reviews
Refer cases that do not meet medical necessity criteria to a medical reviewer for medical necessity determination. Coordinate peer review, medical determination and appeal
Identify before or at the time of admission, any cases which have high case management potential due to large dollar amounts, utilization of out of network provider, multiple providers requiring care integration, or complex discharge planning needs
Identify and appropriately transfer cases for Chronic Illness Management or Complex Case Management/Behavioral Health Case Management as appropriate
Work collegially with PreferredOne providers, requesting, providing, and collaborating in obtaining information as needed
In a timely fashion, contact Manager, Director and Account Manager to make recommendations for flexing or extending benefits to prevent the possibility of using more costly services with equivalent outcomes
Assist with the development of policies, procedures, criteria, exempt and focused review programs etc., as required, refine and revise the risk management process to better meet its dual goals of cost efficiency and quality care delivery
Through collaboration and sharing of information, work with other Preferred One staff to assist in identifying and solving problematic issues through provider education, contracting issues, focused review programs, etc.
Review claims, data from pharmacy benefit administrators and other information available to assess patients who have high case management potential or who would benefit from further integration of medical services
Monitor case information for quality and patient safety issues and refer as needed per company guidelines for further review
Ad hoc activities as designated by management, i.e. training and orienting other staff, arranging in-services, researching clinical information on the internet

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

Required Qualifications:

Compact State Nursing License
5+ years of clinical experience
2+ years of Utilization Management experience in a managed health care setting
Proven excellent communication skills with the ability to interact and collaborate effectively with all levels of the organization and outside clients
Proven good interpersonal skills and ability to work effectively in an environment characterized by high levels of activities
Proven ability to multi-task and prioritize in a fast-paced environment

Preferred Qualifications:

BSN or higher degree
Certified Case Manager
Experience in Case Management
Medical experience in NICU, Transplants, Rehabilitation, Surgical, Home Healthcare and Appeals
Knowledge of insurance industry including benefit plans, reinsurance and State and National mandates (requirements)

Special Requirements:

Compliance with regulatory and accrediting organizations (e.g., MDH, NCQA) and applicable laws and regulations (e.g., HIPAA, Affordable Care Act)
Adherence to internal quality control guidelines and processes (e.g., SOC1)

All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington or Washington, D.C. Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Apply Now

Registered Nurse jobs in Maple Grove, MN

RN Nurse Reviewer - Remote

Registereed Nurse/ RN - Clinic/ Family Practice

Nurse Clinician - Gamma Knife

Registered Nurse/RN - Clinic

Part-Time Home Health Nurse - Minimum 2 Days Per Week!

Part Time Utilization Management Specialist - Remote near Minneapolis, MN

Registered Nurse - Social Service Organization

Registered Nurse (RN)

RN, OB/GYN

Registered Nurse (RN) - Pediatric Emergency Department

RN/LPN

Registered Nurse - RN

Interim Nurse Consultant

Clinic RN

RN Triage Nurse

RN/QUALIFIED PROFESSIONAL (QP)20-40 hours per month

Staff Nurse RN (0.8 FTE) - Brooklyn Park Clinic

Clinic RN

Registered Nurse/Licensed Practical Nurse

Registered Nurse - Endoscopy

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