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Insurance Utilization Reviewer Jobs in Minnesota

Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time ...

Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time ...

Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time ...

Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time ...

Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time ...

Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time ...

Showing results 21-40

Insurance Utilization Reviewer information

What is an insurance utilization reviewer?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.

What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are popular job titles related to Insurance Utilization Reviewer jobs in Minnesota?

For Insurance Utilization Reviewer jobs in Minnesota, the most frequently searched job titles are:

Infographic showing various Insurance Utilization Reviewer job openings in Minnesota as of July 2026, with employment types broken down into 100% Full Time. Highlights an 89% In-person, and 11% Remote job distribution.

MDS RN Nurse in Hillman, MN

Vivian Health

Hillman, MN • On-site

$10K/mo

Other

Medical, Dental, Vision, Life, Retirement

Posted 10 days ago


Job description

MDS - RN Nurse - Woodland - FT - Days
Careers With Purpose
Join our not-for-profit organization that has provided over 100 years of housing and services to seniors with a commitment to quality care and service in a Christian environment.
Facility: Gss Mn Brainerd Wdld
Location: Brainerd, MN
Address: 100 Buffalo Hills Ln W, Brainerd, MN 56401, USA
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 32.00
Salary Range: $40.00 - $51.00
Pay Info: $10,000 Sign-on Bonus!
Department Details
Good Samaritan – Woodland is a 42-bed long-term skilled care and transitional care facility located in Brainerd, Minnesota, in an area known as “The Heart of the Brainerd Lakes Area”.
* Full Time – 64 Hours a bi-weekly pay period
* Day Shift Hours - weekdays
* The MDS Nurse will work 3 shifts a week as the MDS Nurse and 1 shift a week as an RN Staff Nurse
* RN On-call rotation
* Previous experience working as an MDS Nurse preferred
* Must be licensed RN in Minnesota
* Sign-on Bonus (if eligibility requirements are met)
Job Summary
The MDS Nurse uses independent judgment in the planning, organizing, directing, and evaluation of activities of the professional and supportive nursing staff engaged in resident plan of care. Evaluates care provided to each resident and keeps care plans current. Is the direct lead in regards to the Resident Assessment Instrument (RAI) process. MDS Nurse assists in assessment and evaluation of potential admissions. Upon admission, quarterly and annual, the MDS Nurse completes resident assessments. Collaborates with the resident, family or advocate, other inter-disciplinary colleagues, including providers, to assure ongoing care of each resident to provide the best quality of life possible. When functioning on the floor, the Registered Nurse (RN) is responsible for utilizing the nursing process (assessment, diagnosis, outcomes/planning, implementation and evaluation) to provide individualized nursing care to patients. The RN demonstrates competency and practices within the full scope of nursing expertise/knowledge and utilizes appropriate age and population specific standards as designated in their assigned clinical setting. The RN cares for residents in all phases of preventative care, health maintenance, diagnosis, and treatment. The RN is responsible for the coordination of care, resident assessment, resident education and various other nursing interventions.
The RN may serve as charge nurse and delegate appropriate tasks to licensed and unlicensed assistive personnel that are within the job descriptions, skills, resident care needs, and the competence level of the delegate. As charge, the RN provides adequate assistance and support to delegates to ensure safe, reliable administration of resident care and resolution of care and service concerns.
The RN functions within the scopes and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of practice and licensure. The Professional Nursing Practice recognizes the Scope and Standards of Practice and the Code of Ethics for Nurses with Interpretive Statements as published by the American Nurses Association as the foundation of nursing care delivery and professional conduct.
Qualifications
Graduate from a National League of Nursing (NLN) or American Association of Colleges of Nursing (AACN) accredited nursing program is preferred. Bachelor’s Degree in nursing preferred.
Minimum of one-year experience working as licensed nurse with the senior population preferred. Specific services/positions may have additional education, training or experience requirements. Resident Assessment Coordinator-Certified (RAC-CT), management or supervisory experience preferred.
Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required certifications and completes required continuous education units (CEU) and competency training. Affiliation with an outside professional nursing organization is preferred.
Benefits
Good Samaritan offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .
Good Samaritan is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.
Good Samaritan has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0265078
Job Function: Nursing
Featured: No