- Actalent (Des Moines, IA)
- Job Title: Utilization Management Nurse Job Description **Must reside in Iowa or South Dakota** The Utilization Management Nurse is responsible ... with providers to resolve utilization review issues. + Process utilization management requests using clinical knowledge and expertise. + Collaborate… more
- Actalent (Des Moines, IA)
- Utilization Management Nurse - Job Description**Must reside in Iowa or South Dakota** This role involves providing members and healthcare providers with ... quality assurance and production metrics as established for the utilization management unit. Essential Skills + Registered Nurse (RN) or Licensed Practical… 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 ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in CST and MST zones.… more
- CenterWell (Des Moines, IA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Des Moines, IA)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Elevance Health (West Des Moines, IA)
- ** Nurse Reviewer I** This role enables associates to...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... state(s) required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Evolent (Des Moines, IA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Molina Healthcare (Des Moines, IA)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Urbandale Community School District (Urbandale, IA)
- …performance appraisal, education, collegiality, ethics, collaboration, research, resource utilization , communication, program management and health education. ... Job ID: 5227365 Job Description JOB TITLE - Substitute Nurse PURPOSE OF THE POSITION - We are seeking...are eager and available to serve as a substitute nurse . School nursing, a specialized practice of nursing, protects… more
- Sharecare (Des Moines, IA)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Lincoln Financial (Des Moines, IA)
- …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Evolent (Des Moines, IA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- United Therapeutics (Des Moines, IA)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
- Molina Healthcare (Des Moines, 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
- Humana (Des Moines, IA)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- Trinity Health (Des Moines, IA)
- …admissions to assure appropriate patient placement . Focuses on efficient bed utilization when assigning beds, based on patient diagnosis, special needs, physician ... knowledge and teamwork to facilitate cohesive efforts to achieve continuous quality management and excellence in providing for patients and/or populations. . Applies… more
- Molina Healthcare (Des Moines, IA)
- …requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more
- Molina Healthcare (Des Moines, IA)
- …3-5 years clinical practice with managed care, hospital nursing or utilization management experience **Preferred License, Certification, Association** Active, ... the work performance of the HCS-Central Programs staff. Consults with the Management of HCS-Central Programs to devise and implement corrective action as necessary… more
- Molina Healthcare (Des Moines, IA)
- …for timely and accurate reimbursement and data collection. Candidates with previous management and DRG validation experience are highly preferred. Work hours: Monday ... program to build tools, workflow process, training, audits, and production management . * Integrates medical chart coding principles, clinical guidelines, and… more
- Trinity Health (Des Moines, IA)
- …members in specific areas. + Demonstrates knowledge and understanding of management /supervisory responsibilities as identified. + Promotes team concept among all ... responsible for directly evaluating and disciplining staff members. + Works with management and medical staff to evaluate, monitor and enforce specific protocols,… more