- Molina Healthcare (Sioux City, IA)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- Public Consulting Group (Des Moines, IA)
- …sector. To learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager ... Proven working experience in case management, including as a nurse , medical , mental health care manager or...plans. + Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions**… more
- Molina Healthcare (IA)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (IA)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Guardian Life (Des Moines, IA)
- …providing comprehensive medical reviews and analysis of long-term disability claims . The RN Clinical Consultant identifies restrictions, limitations and ... duration impacting functional capacity based on medical data, to assist the Claim Managers...The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants' medical… more
- Access Dubuque (Dubuque, IA)
- …Date 20250419 End Date 20250622 Featured Job TH Ad TH Comments **Similar Jobs** Clinic RN - Registered Nurse : Oncology/ Palliative MercyOne Registered ... with the purpose of the job as directed. **Minimum Qualifications:** + Must be a registered nurse and must hold an active license to practice nursing in the… more
- Elevance Health (West Des Moines, IA)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Sedgwick (Dubuque, IA)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on claims .… more
- Access Dubuque (Dubuque, IA)
- Bilingual RN Case Manager **Cottingham & Butler/ SISCO** 1 Positions ID: 4677023008 Posted On 05/07/2025 **Job Overview** We are seeking a compassionate and ... detail-oriented **Bilingual RN Case Manager** to join our team. This role...**Key Responsibilities:** + Provide telephonic case management and utilization review for assigned consumers. + Develop, implement, and monitor… more
- JBS USA (Ottumwa, IA)
- …screen. Review physician reports on employee's health, workers' compensation insurance claims , medical restrictions on employee's work and the policies and ... DIVISION/DEPARTMENT: PORK LOCATION: OTTUMWA, IA JOB TITLE: 1ST SHIFT EMT/PARAMEDIC/LPN/ RN REPORTS TO: OCCUPATIONAL HEALTH MANAGER General Description: Respond to… more
- Sedgwick (Des Moines, IA)
- …accredited college or university preferred. Current Certified Rehabilitation Counselor (CRC) or Registered Nurse ( RN ) license required. Current license, ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims , including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more
- Lincoln Financial (Des Moines, IA)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you… more
- Otsuka America Pharmaceutical Inc. (Des Moines, IA)
- …to travel up to 25%.** **Educational Qualifications** Required: + Bachelor's Degree or Registered Nurse ( RN ). Minimum of 10 years industry experience ... and guidance, ICH/GCP, and Otsuka SOPs.** **Contribute to the development and review of all critical clinical study documents, including clinical protocols, informed… more
- Lincoln Financial (Des Moines, IA)
- …duties as required. **What we're looking for** * Minimum of 5 years of disability claims experience * Current Registered Nurse license or Licensure in ... you will be responsible for leading and managing a team of nurse disability consultants and behavioral health consultants. This includes partnering closely with… more
- Elevance Health (West Des Moines, IA)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- Access Dubuque (Dubuque, IA)
- …equivalent of at least three fulltime years of recent experience as a registered nurse with emergency room experience. Teaching experience or training experience ... Evidence a commitment to ongoing program evaluation. a. Annual review of Annual Key Performance Indicator Review ...lab assistants. f. Assist in the coordination of the medical director's involvement in the Paramedic Program and process… more
- Lincoln Financial (Des Moines, IA)
- …at a Glance** We are excited to bring on a Clinical Director to our claim 's organization. This role will be remote, or hybrid based on the proximity to Charlotte ... stakeholders that require collaboration with resources from clinical and claims . * Directs operational workforce & volume analysis, including analysis… more
- Evolent (Des Moines, IA)
- …+ Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of ... and write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet all accreditation,… more
- Sedgwick (Des Moines, IA)
- …new business plan with goals and objectives for assigned locations/offices; provides expert medical and product support to Sedgwick claims and clinical staff. ... cost effective, and high quality delivery of case management and utilization review services to clients for multiple business lines; and to provide expertise… more
- Elevance Health (West Des Moines, IA)
- **Telephonic Nurse Case Manager I** **Location: Virtual:** **This role enables associates to work virtually full-time, with the exception of required in-person ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager I** is responsible for performing care...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisor's on the development of… more