- George C. Grape Community Hospital (Hamburg, IA)
- Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... infection control, and payers to resolve care coordination issues. Qualifications: * Education: Registered Nurse ( RN ) license required; BSN preferred. *… more
- UnityPoint Health (Cedar Rapids, IA)
- …Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a ... coordinating the department's interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-quality health care,… more
- Molina Healthcare (Sioux City, IA)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), claims… 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 ... unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Trinity Health (Davenport, IA)
- …Life Support + Training Preferred: Certification in Case Management, Professional Utilization Review or Managed Care; DRG/CPT knowledge; Interqual ... for patient safety. We are looking to hire an RN - Case Manager to join our Care Coordination...Admission/Continued Stay criteria knowledge + Licensure/Registration: Registered Nurse in Iowa or Illinois at… 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 ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- UnityPoint Health (Anamosa, IA)
- …to provide continuity of care. + Functions under all accountabilities of the Registered Nurse position. + Works with patients/families to identify their goals ... the healthcare team to ensure safe/optimal outcomes for patients/families. Utilization Review + Reviews admission data to...Current licensure in good standing to practice as a Registered Nurse in Iowa. + Must possess… more
- UnityPoint Health (Grinnell, IA)
- …MDS forms in a timely manner. Quality of Care * Performs Quality and Utilization Review data collection and activities as assigned. * Monitors severity of ... care nursing required * Current knowledge of discharge planning and utilization review activities preferred License(s)/Certification(s): * Current Iowa license… more
- Fresenius Medical Center (Dubuque, IA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- UnityPoint Health (Cedar Rapids, IA)
- …home care. Responsible for case coordination of patients and insurance precertification/ utilization review . Patients served include adult and geriatric. St. ... Coordinates cases with community agencies, referral sources. + Manages utilization review for own patients with insurance...Current licensure in good standing to practice as a Registered Nurse in [type in State]. +… more
- Access Dubuque (Dubuque, IA)
- …also available remotely. **Key Responsibilities:** + Provide telephonic case management and utilization review for assigned consumers. + Develop, implement, and ... Bilingual RN Case Manager **Cottingham & Butler/ SISCO** 1...Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. + **Skills:**… more
- Trinity Health (Davenport, IA)
- …Basic Life Support Training Preferred: Certification in Case Management, Professional Utilization Review or Managed Care; DRG/CPT knowledge; Interqual ... Admission/Continued Stay criteria knowledge Licensure/Registration: Registered Nurse in Iowa or Illinois at time of hire, second state required within 1 year.… more
- Accura Healthcare (Shell Rock, IA)
- …to ensure complete, current, and accurate medical records. QUALIFICATIONS: + Hold current Registered Nurse ( RN ) license with applicable state, without ... join our team! We're seeking a skilled and compassionate registered nurse to manage and oversee the...use in the evaluation of quality of care and utilization review for the purpose of clinical… more
- Accura Healthcare (Lake City, IA)
- …complete, current, and accurate medical records. QUALIFICATIONS: + Current licensure as a Registered Nurse ( RN ) in the applicable state, without ... City has the opportunity to welcome a MDS Coordinator ( RN ) to join our team! Our MDS Coordinators are...use in the evaluation of quality of care and utilization review for the purpose of clinical… more
- UnityPoint Health (Iowa City, IA)
- …services. * Is knowledgeable regarding managed care implications - precertification and utilization review procedures. * Assists with crisis services placement, ... work-related reasons. . Current licensure in good standing to practice as a Registered Nurse in Iowa. . Must possess and maintain current Basic Life Support… more
- UnityPoint Health (Cedar Rapids, IA)
- …of patient care on the behavioral health units under the direction of a registered nurse . Responsible for the delivery of patient care through a ... Is knowledgeable regarding managed care implications - precertifications and utilization review + Maintains competence in performing...in good standing to practice as a licensed practical nurse in the state of Iowa. + Must possess… 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 ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Sioux City, IA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...cost-effective member care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare… more
- Molina Healthcare (Sioux City, IA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION For this position we are seeking a RN with a current active license for state of...state of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide… more
- UnityPoint Health (Fort Dodge, IA)
- …week; no nights or weekends! Possible call shifts. + Job ID: 175357 Overview Registered Nurse ( RN ) Outpatient Surgery/Endoscopy (4) 8-hour shifts per week. ... to health, wellness, and disease management and prevention. The registered nurse is able to exercise good...goals of nursing unit and maintaining awareness of resource utilization . + Participates in non-direct patient care activities including… more