- Healthfirst (IA)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- CVS Health (Des Moines, IA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in central zones.… more
- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Baylor Scott & White Health (Des Moines, IA)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- Molina Healthcare (Sioux City, IA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- UnityPoint Health (Waterloo, IA)
- …population, ensuring that adequate discharge plans are in place and completing utilization management and quality review activities. Care is provided through ... activities are concurrently accessible to the healthcare team.Maintains knowledge of utilization management criteria and communicates with Utilization … more
- Evolent (Des Moines, IA)
- …Doing:** 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 ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...**Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing … more
- Humana (Des Moines, IA)
- …course of action. **Key Functions:** + Serves as a liaison between Humana utilization management (UM) operations, Humana's Risk and Compliance lines of defense, ... regarding prior authorization reviews, prepayment retrospective reviews, and any additional utilization management functions. + Develop and implement … more
- CVS Health (Des Moines, IA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Specialty Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CVS Health (Des Moines, IA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- UnityPoint Health (Des Moines, IA)
- …agencies and payers to plan and execute a safe discharge + Collaborate with Utilization Management team on continued stay review. Key Accountability - Discharge ... + Document education related to medication adherence + Facilitate patient self- management education. Qualifications Education: Associate's degree in nursing (… more
- Select Medical (Davenport, IA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Humana (Des Moines, IA)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Highmark Health (Des Moines, IA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Elevance Health (IA)
- … preferred. + Participation and/or certification in a managed care or utilization management organization preferred. + Ability to understand clinical information ... a two-week period, including Saturday and Sunday every other weekend. The **Triage Nurse I - Carebridge** is responsible for determining the appropriate Care … more
- Molina Healthcare (IA)
- …Experience** 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
- UnityPoint Health (Waterloo, IA)
- …population, ensuring that adequate discharge plans are in place and completing utilization management and quality review activities. Care is provided through ... + FTE/Hours per pay period: 1.0 + Department: Case Management + Shift: Mon-Friday 8-4:30, 5-6 weekends per year,...an accredited nursing program. Baccalaureate degree in nursing preferred. + Two years of registered nurse… more
- UnityPoint Health (West Des Moines, IA)
- …(before 1200) discharge. + Ensures accurate patient class, in collaboration with Utilization Management , in support of compliance and revenue integrity ... to ensure the meeting or improvement of organizational goals related to Capacity Management Qualifications Education: + Bachelors Degree in Nursing Experience: +… more
- Urbandale Community School District (Urbandale, IA)
- …are seeking qualified individuals who are eager and available to serve as a substitute nurse . School nursing , a specialized practice of nursing , protects and ... care, performance appraisal, education, collegiality, ethics, collaboration, research, resource utilization , communication, program management and health education.… more
- UnityPoint Health (West Des Moines, IA)
- …and present to a wide variety of leaders in all markets, Utilization Management , Strategy, and Finance. Other collaborative partnership opportunities will ... with system transfer center leaders Qualifications Education: + BA/BS in Nursing , Healthcare Administration, Allied Health, Project Management , Business, or… more