- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Trinity Health (Des Moines, IA)
- …The UM Lead is responsible for overseeing day-to-day activities within the Utilization Management (UM) department, including staffing, assignment management , ... policies to ensure adherence. **Minimum Qualifications:** + Comprehensive knowledge of Utilization Management , typically gained through a bachelor's degree in… more
- UnityPoint Health (Cedar Rapids, IA)
- …changes for compliance + Documents the case management plan to include: clinical needs, barriers to quality care, effective utilization of resources and ... medical cost management , including best practices, effective utilization of resources, linking clinical and financial...team-oriented approach + Ability to give work direction to non- clinical staff + Use of usual and… more
- George C. Grape Community Hospital (Hamburg, IA)
- …infection control outcomes. * Education & Collaboration: o Educate clinical staff on documentation requirements, utilization management processes, and ... infection control standards. o Serve as a liaison between clinical teams, case management , infection control, and payers to resolve care coordination issues.… more
- Humana (Des Moines, IA)
- …Lead- Florida develops, maintains, and/or operationalizes formularies related to coverage, utilization management edits, or clinical coverage policies ... Develops corporate communications to be shared with senior leadership. Supports trend management by conducting analysis of drug spend, utilization , and/or… more
- Access Dubuque (Dubuque, IA)
- …and proficiency in case management for provision of care, clinical expertise, documentation, utilization effectiveness, patient experience and quality ... competencies throughout the orientation period. * Validates the ongoing competencies of current clinical staff as directed by the Ambulatory Clinical … more
- UnityPoint Health (Dubuque, IA)
- …and proficiency in case management for provision of care, clinical expertise, documentation, utilization effectiveness, patient experience and quality ... orientation period. * Validates the ongoing competencies of current clinical staff as directed by the Ambulatory... management skills. * Ability to critically think and make clinical decisions based on verbal and written… more
- Highmark Health (Des Moines, IA)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- Fresenius Medical Center (Dubuque, IA)
- …courses and that licensures/certifications are current. + Provides support for all clinical staff members at regular intervals and encourages professional ... eligibility for treatment. + Reports changes in patient status regarding any clinical , insurance, or travel and transportation issues. STAFF : + Participates… more
- Evolent (Des Moines, IA)
- …is responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under ... directed by the office of the Chief Medical Officer. + Responsible for clinical conversations with providers and their office staff regarding medical necessity… more
- Trinity Health (Newton, IA)
- … responsibilities as assigned. Serves as the department's Clinical Education Coordinator conducting needs assessments, objective development, orientation ... approach. + Provides consultation upon request in area of clinical expertise to other nursing staff or...may represent the department on hospital committees or attend management meetings. **CARE COORDINATION** + Plans resource utilization… more
- CVS Health (Des Moines, IA)
- …each and every day. The supervisor is responsible for oversight of healthcare management staff including the organization and development of high performing ... teams. Works closely with functional area management to ensure consistency in clinical interventions...experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience… more
- Prime Therapeutics (Des Moines, IA)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... visa or residency sponsorship **Additional Qualifications** + 3-5 years' experience in clinical operations, quality, network, pharmacy or project management OR a… more
- Evolent (Des Moines, IA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- UnityPoint Health (Des Moines, IA)
- …+ Sign On Bonus: $10,000 + FTE/Hours per pay period: 1.0 + Department: Clinical Dietetics + Shift: M-F 8a-4:30p; rotating Saturdays + Job ID: 174792 Overview The ... Clinical Nutrition Specialist is responsible for assisting UnityPoint Health-Des...or actual concerns immediately. + Oversees technical and support staff in the absence of administrative leadership personnel. +… more
- Molina Healthcare (IA)
- …at least 3 or more years in one or more of the following areas: utilization management , care management , care transitions, behavioral health, or equivalent ... work of external vendors. * Focuses on process improvement, organizational change management , program management and other processes relative to business needs.… more
- Evolent (Des Moines, IA)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Highmark Health (Des Moines, IA)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Evolent (Des Moines, IA)
- …Cardiologist)** Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical ... appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and clinical staff to address complex cases and… more
- Molina Healthcare (Des Moines, IA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more