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Date Added: Fri 11/06/2021

Utilization Management Specialist, RN

Stillwater, MN, US
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Job Type: Permanent, FullTime

Job Description

Bluestone Physician Services is the largest provider of residential geriatric primary-care in the nation. Our physician-led teams serve thousands of patients across multiple states within Assisted Living Homes, Memory Care Units, and Group Homes. Bluestone has proven that personal engagement, quality of care and exceptional service, results in high patient and staff satisfaction.

The Utilization Management Specialist (RN) is responsible for supporting Bluestone's value-based care initiatives by conducting detailed reviews of high cost/high-risk patients. This role will have strong emphasis on home health care along with hospital and skilled nursing utilization. This is a data driven role that will require knowledge of clinical guidelines and billing/benefits requirements, particularly as it relates to home health care. The primary function of this role is to evaluate patient progress throughout via chart review and collaborate with care teams in all Bluestone markets to ensure that our patients receive the most effective and appropriate care to meet their needs.

This position will be based out of the Stillwater, MN office.


  • Conduct prospective, concurrent, and retrospective reviews of high cost/high-risk patients included in value-based care initiatives
  • Obtain necessary medical data, reports, and subsequent treatment plans to conduct ongoing reviews
  • Use clinical knowledge to apply evidence-based criteria to determine appropriateness of level and length of care
  • Ensure procedures, interventions, and equipment are the most appropriate and medically necessary
  • Evaluate patient progress via chart review and/or collaboration with health care team partners
  • Continually monitor the appropriateness of home health care certifications and analyze records to proactively
  • assess and make recommendations for impending home health care recertifications
  • Identify and resolve barriers which may hinder effective patient care
  • Participate in interdisciplinary collaboration with health care team partners including care coordinators,
  • physicians, clinicians, and care managers, on level of care, identified barriers, and other concerns related to
  • utilization management
  • Develop utilization management processes in conjunction with population health and clinical teams
  • Ensure Medicare/Medicaid regulatory guidelines are followed
  • Other duties as assigned


  • Current MN Registered Nurse licensure required
  • 3-5 years of home health management experience required
  • Bachelor's degree in Nursing preferred
  • 1-3 years of utilization review experience preferred
  • Prior experience using EHR systems
  • Proficient computer skills, specifically using Microsoft Excel
  • Excellent written and verbal communication skills
  • Strong attention to detail, follow-through, and commitment to quality
  • Strong technical and analytical skills
  • Strong interpersonal and customer service skills
  • Skill in identifying, analyzing, and creatively resolving problems
  • Ability to work well under pressure and with constantly shifting priorities
  • Ability to work with diverse populations
  • Ability to work cooperatively to meet department and company goals and timelines
  • Strong organizational skills with the ability to prioritize, manage multiple tasks, and meet deadlines
  • Ability to deal with change and ambiguity
  • Computer proficiency including Google Docs, Excel, EHR and equipment such as iPad, and iPhone
  • Demonstrated compatibility with Bluestone's mission and operating philosophies
  • Demonstrated ability to read, write, speak, and understand the English language
  • Must have received or be willing to receive Covid 19 vaccine by date of hire. Accommodations for disability- and religious-based reasons will be considered.

Why Bluestone?

Bluestone Physician Services was founded in 2006, and is now on the leading edge of Healthcare delivery. We bring healthcare services to the patients that we serve within the comfort of their own homes. Bluestone is one of the largest providers of residential primary-care in the nation, serving thousands of patients across multiple states within Assisted Living Homes, Memory Care Units, and Group Homes. Bluestone has been named to the Star Tribune's Top Workplaces in MN, making the list 8 year's in row!

Bluestone offers excellent Benefits to our employees including:

  • Competitive wages
  • Health Insurance
  • Dental Insurance
  • Vision Materials Insurance
  • Company paid Life Insurance
  • Company paid Short and Long-term Disability
  • Health Savings Account (HSA)
  • Flexible Spending Account (FSA)
  • Retirement plan with 4% matching contributions
  • Paid Time Off (PTO)
  • Nine paid (non-working) holidays
  • Regular business hours; no weekends

By working here, you have the chance to make a difference in the lives of others. Our success has translated into a rapidly-growing organization, offering career opportunities in recognition of hard work. To find more information about exciting opportunities within our innovative and ever-growing organization, please visit #removed#

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