- 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 ET and CT time 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
- 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
- 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)
- …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
- 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
- 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
- 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
- Molina Healthcare (Des Moines, 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
- 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
- Molina Healthcare (Des Moines, IA)
- …preferred. **Preferred Experience** 3-5 years clinical practice with managed care, hospital nursing or utilization management experience **Preferred License, ... 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
- 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
- Elevance Health (West Des Moines, IA)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... work counseling or a related behavioral health field or a degree in nursing , and minimum of 3 years of experience with facility-based and/or outpatient psychiatric… 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
- Sedgwick (Des Moines, IA)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business ... lines; and to provide expertise in client specific case management and utilization review requirements and ensure...territory of the United States required. Certification in case management required. Bachelor's degree in nursing (BSN)… more
- Sharecare (Des Moines, IA)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse...Hours are on Central Standard Time. _ A compact nursing license is required for this position_ **Essential Job… more