- George C. Grape Community Hospital (Hamburg, IA)
- Quality / Utilization Review Nurse Position Summary: The Quality / Utilization Review Nurse is responsible for evaluating the medical ... years of clinical nursing experience (acute care preferred). o Prior experience in utilization review , case management, quality improvement, and infection… more
- Molina Healthcare (Sioux City, IA)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- CVS Health (Des Moines, IA)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Evolent (Des Moines, IA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Urbandale Community School District (Urbandale, IA)
- Job Details Job ID: 5227365 Job Description JOB TITLE - Substitute Nurse PURPOSE OF THE POSITION - We are seeking qualified individuals who are eager and available ... to serve as a substitute nurse . School nursing, a specialized practice of nursing, protects...health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that… more
- Highmark Health (Des Moines, IA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... in achieving their personal health goals. Will work with providers to insure quality and appropriate care is being delivered in a timely manner. **ESSENTIAL… more
- Trinity Health (Davenport, IA)
- …Life Support + Training Preferred: Certification in Case Management, Professional Utilization Review or Managed Care; DRG/CPT knowledge; Interqual ... Illinois. But when it comes to clinical capabilities and quality , we exceed those geographical limits. We have earned...Admission/Continued Stay criteria knowledge + Licensure/Registration: Registered Nurse in Iowa or Illinois at time of hire,… more
- UnityPoint Health (Waterloo, IA)
- …patient population, ensuring that adequate discharge plans are in place and completing utilization management and quality review activities. Care is provided ... role in the multidisciplinary effort to identify and deliver quality and cost-efficient healthcare to patients. While the role...family. + Communicates the discharge plan to the primary nurse and healthcare team through verbal updates and handoff… more
- Evolent (Des Moines, IA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Evolent (Des Moines, IA)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... to ensure client satisfaction. + Perform all peer clinical review activities while located in a state or territory...Analytic skills Energetic and curious with a passion for quality and value in health care Required to pass… more
- Fresenius Medical Center (Dubuque, IA)
- …As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility ... Manages the operations of the clinic, including costs, processes, staffing, and quality standards. + Provides leadership, coaching, and development plans for all… more
- Molina Healthcare (Des Moines, IA)
- …care unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Sioux City, IA)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. We are seeking candidates with a RN… more
- Molina Healthcare (IA)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Sioux City, IA)
- …current active license for state of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and ... speed required. Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Des Moines, IA)
- … of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the… more
- UnityPoint Health (Anamosa, IA)
- …members of the healthcare team to ensure safe/optimal outcomes for patients/families. Utilization Review + Reviews admission data to determine medical necessity ... the recognition, research, isolation and resolution of potential problems related to utilization review . + Establishes and implements a program of concurrent… more
- Highmark Health (Des Moines, IA)
- …coding criteria, as well as other approved guidelines, payment and medical policies.Promote quality and efficiency in the delivery of review services. + Respect ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- UnityPoint Health (Grinnell, IA)
- …and submits MDS forms in a timely manner. Quality of Care * Performs Quality and Utilization Review data collection and activities as assigned. * ... care nursing required * Current knowledge of discharge planning and utilization review activities preferred License(s)/Certification(s): * Current Iowa license… more
- Access Dubuque (Dubuque, IA)
- …in case management for provision of care, clinical expertise, documentation, utilization effectiveness, patient experience and quality outcomes. * Completes ... Participates in interdisciplinary team meetings and case conferencing to ensure patient quality care, patient advocacy, utilization and outcomes **Subject Matter… more