- Evolent (Des Moines, IA)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Molina Healthcare (Des Moines, IA)
- …for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review...clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- Iowa Department of Administrative Services (Mitchellville, IA)
- …accredited college or university with a Master's Degree in Nursing and certification as a clinical nurse specialist, nurse midwife, nurse practitioner or ... Full-time Job Number 26-00855 Agency 244 Corrections - Iowa Medical and Classification Center (Oakdale) Opening Date 10/01/2025 Closing...YES - Do you have a certification as a clinical nurse specialist, nurse midwife,… more
- BioLife Plasma Services (Des Moines, IA)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife ... of laboratory test results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works under the guidance of… more
- Iowa Department of Administrative Services (Mitchellville, IA)
- …Boards of Nursing is available at theNurse Licensure Compact (https://nursing.iowa.gov/practice/ nurse -licensure-compact) . Review the provisions of the statute ... Licensed Practical Nurse Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/5043446) Apply Licensed Practical Nurse Salary $52,790.40 -… more
- CVS Health (Des Moines, IA)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- Trinity Health (Des Moines, IA)
- …care areas, may perform or demonstrate patient care tasks which may expose the clinical nurse to infectious or communicable disease, or possibility of injury ... safe, effective, and culturally competent care for patients with acute medical and surgical conditions. Through evidence-based practice, utilizes critical thinking… more
- WesleyLife (Johnston, IA)
- …growth and purpose. Come be a part of the revolution! **About the Role: Registered Nurse Supervisor** As a Registered Nurse Supervisor, you'll play a key role in ... the residents at Brio in Johnston. **As a Registered Nurse Supervisor, you will:** + Oversee Staff and Patient...performance. + Handle Emergencies and Critical Situations: Respond to medical emergencies or urgent situations, such as falls, sudden… more
- Surgery Care Affiliates (West Des Moines, IA)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Veterans Affairs, Veterans Health Administration (Des Moines, IA)
- …care provider (MD, NP, PA), registered nurse care manager, clinical associate (LPN or medical assistant/health technician), and administrative associate ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… more
- Cardinal Health (Des Moines, IA)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Des Moines, IA)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Molina Healthcare (Des Moines, IA)
- …records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers. + Implements Molina Healthcare ... completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse ... records collection and abstraction * 2+ years of medical record review experience **REQU** **I** **RED… more
- Sedgwick (Des Moines, IA)
- …need for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims; documents decision rationale; and ... Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist **PRIMARY PURPOSE** : To perform clinical...completes medical review of all claims to ensure… more
- Molina Healthcare (Des Moines, IA)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents cases in a consistent… more
- Molina Healthcare (Des Moines, IA)
- …, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more
- Molina Healthcare (Des Moines, IA)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Des Moines, IA)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Des Moines, IA)
- …compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Molina Healthcare (Des Moines, IA)
- …of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality...Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review ,… more