- Cognizant (Des Moines, IA)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Des Moines, IA)
- …we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- CVS Health (Des Moines, IA)
- …Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization . **Required Qualifications** + Registered Nurse (RN) ... CVS Health Aetna has an opportunity for a full-time Utilization Management (UM) Nurse Consultant. As a...Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills… more
- Humana (Des Moines, IA)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse (RN) in a compact state… more
- CVS Health (Des Moines, IA)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- CVS Health (Des Moines, IA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- CVS Health (Des Moines, IA)
- …Service/Health Services (as applicable to hiring program) or Associates degree with a Registered Nurse with Behavioral Health experience/ background with 3 years ... we do it all with heart, each and every day. **Position Summary** Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization… more
- Evolent (Des Moines, IA)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Molina Healthcare (Des Moines, IA)
- …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....or modification of payment decisions. * Serves as a clinical resource for utilization management, chief medical… more
- UnityPoint Health (Des Moines, IA)
- …Meth + Shift: 0.01 + Job ID: 171109 Overview PRN- As Needed The hospitalist nurse is a registered nurse , working in collaboration with the hospitalist ... clinical needs, barriers to quality care, and effective utilization of resources. + Verifies primary care provider and...Current licensure in good standing to practice as a Registered Nurse in Iowa Experience: + Minimum… more
- Sharecare (Des Moines, IA)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- Molina Healthcare (Des Moines, IA)
- …skills. + Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** + Registered Nurse (RN). The license must be active and ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Molina Healthcare (Des Moines, IA)
- …and electronic medical record (EMR) experience. Preferred Qualifications * Experience as a registered nurse or nurse practitioner in a home health, ... primary care and medical care services to members - primarily in non- clinical settings where members feel most comfortable, including in-home, community and nursing… more
- Molina Healthcare (Des Moines, IA)
- …for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and ... of Nursing **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or… more
- Molina Healthcare (Des Moines, IA)
- …* At least 3 years health care management/leadership experience. * Registered Nurse (RN) or other advanced clinical or medical licensure. License must be ... active and unrestricted in state of practice. * Deep understanding of clinical operations: utilization management, care management, etc. * Ability to provide… more
- Molina Healthcare (Des Moines, IA)
- …behavioral health, or equivalent combination of relevant education and experience. + Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed ... **Required Qualifications** + At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of… more
- UnityPoint Health (Des Moines, IA)
- …as identified. Qualifications Education: A graduate of an accredited school of nursing. Registered Nurse currently licensed to practice in the State of Iowa. ... transitions of care; achievement of select quality outcome metrics; appropriate utilization of health management programs and resources, within the structure of… more
- Molina Healthcare (Des Moines, IA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Molina Healthcare (Des Moines, IA)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Veterans Affairs, Veterans Health Administration (Des Moines, IA)
- …care team that generally consists of a primary care provider (MD, NP, PA), registered nurse care manager, clinical associate (LPN or medical assistant/health ... nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and nursing staff) to accomplish team goal setting… more