- Actalent (Des Moines, IA)
- Utilization Management Nurse Job Description We are seeking a dedicated Utilization Management Nurse to provide members and healthcare providers ... utilization review issues and explore alternative treatment options. + Process utilization management requests using clinical knowledge to interpret medical… more
- CVS Health (Des Moines, IA)
- …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
- Humana (Des Moines, IA)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… more
- Molina Healthcare (Sioux City, IA)
- …for RN, LVN, or bachelor's trained candidates with a strong background in Utilization Management . Additionally, the applicant should have proven experience as a ... Responsible for the development, implementation, and delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. Leads… more
- Trinity Health (Des Moines, IA)
- …the STAR admitting system. ESSENTIAL FUNCTIONS: + Conducts admission review per the Utilization Management Plan to ensure that the hospitalization is approved ... of the change. + Documents in the Medical Record Utilization Management forms accurately to reflect the...AND ABILITIES REQUIRED:** + Current licensure as a registered nurse in the State of Iowa. + Five (5)… more
- Trinity Health (Des Moines, IA)
- …Type:** Full time **Shift:** **Description:** **_Are you an experienced Director of Care Management & Utilization Review looking for an interim assignment? Join ... Des Moines. Operational responsibilities include budgeting, strategic planning, patient care management and integration and achieve organizational goals. Acts as a… more
- Trinity Health (Mason City, IA)
- …+ Works directly with members of care team to effectively ensure appropriate acute utilization management + Interacts with outside review agencies and payors to ... Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case screening, insurance approval,… more
- Molina Healthcare (Cedar Rapids, IA)
- …in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Evolent (Des Moines, IA)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Waverly Health Center (Waverly, IA)
- …nursing unit dealing with providers and patient's records and have functional knowledge of utilization management and case management . c. Must have strong ... of nursing and currently licensed to practice as a Registered Nurse in Iowa. Certification in case management and BSN preferred. b. Minimum of three to five… more
- Avera (Sioux Center, IA)
- …**Position Highlights** **Registered Nurse ** **Summary** + The RN assists the Resource Nurse in the management and care of their assigned patients by means ... Nurse ** **Summary** + The LPN assists the registered nurse in the management and care of...Communicates pertinent information to staff. + Displays proper care, utilization , and charging of supplies and equipment used. +… more
- Veterans Affairs, Veterans Health Administration (Iowa City, IA)
- …health care that improves their health and well-being. Critical Care Registered Nurse (RN) is responsible for providing competent, evidence-based care to assigned ... to the setting. Major duties include, but are not limited to: The nurse will assist in directing the provision of nursing education, orientation, competencies and… more
- Molina Healthcare (IA)
- …contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… more
- Actalent (Des Moines, IA)
- …and process improvement initiatives. Responsibilities + Support adherence to processes within Utilization Management and Case Management . + Review and ... Job Title: Quality Nurse Coach Job Description As a Quality ...+ Conduct quality assurance reviews of call interactions within Utilization Management and Case Management .… more
- Molina Healthcare (IA)
- **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... are most receptive including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in non-clinical settings and… more
- Avera (Rock Rapids, IA)
- …May be eligible for a relocation bonus **Student Loan Repayment:** This Registered Nurse (RN) position may be eligible for Avera's Student Loan Repayment Program, ... where you matter.** **A Brief Overview** Responsible for the care planning, utilization of services, coordination of care, and the education of the interdisciplinary… more
- KidsPeace Childrens Hospital (Varina, IA)
- The Certified Registered Nurse Practitioner (CRNP) is responsible for overseeing the psychiatric needs of children, adolescents, and/or adults, with primary focus on ... conducting educational workshops and in service training for staff. The Nurse Practitioner will adhere to evidence-based practice guidelines, professional standards,… more
- Urbandale Community School District (Urbandale, IA)
- …performance appraisal, education, collegiality, ethics, collaboration, research, resource utilization , communication, program management and health education. ... qualified individuals who are eager and available to serve as a substitute nurse . School nursing, a specialized practice of nursing, protects and promotes student… more
- Trinity Health (Davenport, IA)
- …adolescent through aging adult cardiovascular patients. This includes support for management of human, fiscal, material, and environmental resources in accordance ... and performance improvement activities; promoting evidence-based practice through research utilization or conduct of practice research. Report To: Manager… more
- Intermountain Health (Des Moines, IA)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more