- Actalent (Des Moines, IA)
- Utilization Management Nurse Job Description We are seeking a dedicated Utilization Management Nurse to provide members and healthcare providers ... utilization review issues and explore alternative treatment options. + Process utilization management requests using clinical knowledge to interpret medical… more
- CVS Health (Des Moines, IA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST or CST zones.… more
- Humana (Des Moines, IA)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… more
- Trinity Health (Des Moines, IA)
- …the STAR admitting system. ESSENTIAL FUNCTIONS: + Conducts admission review per the Utilization Management Plan to ensure that the hospitalization is approved ... of the change. + Documents in the Medical Record Utilization Management forms accurately to reflect the...AND ABILITIES REQUIRED:** + Current licensure as a registered nurse in the State of Iowa. + Five (5)… more
- Trinity Health (Des Moines, IA)
- …Type:** Full time **Shift:** **Description:** **_Are you an experienced Director of Care Management & Utilization Review looking for an interim assignment? Join ... Des Moines. Operational responsibilities include budgeting, strategic planning, patient care management and integration and achieve organizational goals. Acts as a… more
- Molina Healthcare (Des Moines, IA)
- **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... are most receptive including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in non-clinical settings and… more
- Actalent (Des Moines, IA)
- …and process improvement initiatives. Responsibilities + Support adherence to processes within Utilization Management and Case Management . + Review and ... Job Title: Quality Nurse Coach Job Description As a Quality ...+ Conduct quality assurance reviews of call interactions within Utilization Management and Case Management .… more
- Molina Healthcare (Des Moines, IA)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Sharecare (Des Moines, IA)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Urbandale Community School District (Urbandale, IA)
- …performance appraisal, education, collegiality, ethics, collaboration, research, resource utilization , communication, program management and health education. ... qualified individuals who are eager and available to serve as a substitute nurse . School nursing, a specialized practice of nursing, protects and promotes student… more
- Highmark Health (Des Moines, IA)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Lincoln Financial (Des Moines, IA)
- …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Evolent (Des Moines, IA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Molina Healthcare (Des Moines, IA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Molina Healthcare (Des Moines, IA)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Highmark Health (Des Moines, IA)
- …timeframes and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Document, process and route requests for services to the nurse reviewer and other departments based on documentation procedures,...and management + Route Cases Based on Established Guidelines +… more
- Sharecare (Des Moines, IA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Actalent (Des Moines, IA)
- …Title: Quality Coach Job Description Support the company's adherence to processes within Utilization Management and Case Management . This role includes ... systems to ensure compliance with HIPAA requirements. + Support Utilization Management and Case Management ...accredited registered nursing program. + Active and Unrestricted Registered Nurse (RN) license in Iowa or South Dakota. +… more
- Trinity Health (Des Moines, IA)
- …admissions to assure appropriate patient placement . Focuses on efficient bed utilization when assigning beds, based on patient diagnosis, special needs, physician ... knowledge and teamwork to facilitate cohesive efforts to achieve continuous quality management and excellence in providing for patients and/or populations. . Applies… more
- Molina Healthcare (Des Moines, IA)
- …requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more