- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Des Moines, IA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Des Moines, IA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CenterWell (Des Moines, IA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Cognizant (Des Moines, IA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Des Moines, IA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
- Humana (Des Moines, IA)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Actalent (West Des Moines, IA)
- …of Medicare and Medicaid regulations preferred. + Familiarity with utilization management processes preferred. + Licensed Practical Nurse (LPN) - State ... Prior Authorization Nurse Job Description This role involves analyzing prior...document, and maintain all members' clinical information in health management systems to ensure compliance with regulatory guidelines. +… more
- Sharecare (Des Moines, IA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Molina Healthcare (Des Moines, IA)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- Humana (Des Moines, IA)
- …experience in an acute care, skilled or rehabilitation setting, home health, DME, triage, utilization , or case management . + **Ability to work ANY 8-hour shift ... caring community and help us put health first** The Nurse Advice Line is a fast-paced inbound call center...+ Bachelor's degree in nursing (BSN) + Previous case management , utilization review, or triage experience +… more
- Molina Healthcare (Des Moines, IA)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Molina Healthcare (Des Moines, IA)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Urbandale Community School District (Urbandale, IA)
- …performance appraisal, education, collegiality, ethics, collaboration, research, resource utilization , communication, program management and health education. ... Job ID: 5227365 Job Description JOB TITLE - Substitute Nurse PURPOSE OF THE POSITION - We are seeking...are eager and available to serve as a substitute nurse . School nursing, a specialized practice of nursing, protects… 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 ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Actalent (West Des Moines, IA)
- …+ Collects, documents, and maintains all member's clinical information in health management systems to ensure compliance with regulatory guidelines + Assists with ... providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members +… more
- Trinity Health (Des Moines, IA)
- …directly evaluating and disciplining staff members. + Works with individual clinic management and medical staff to evaluate, monitor and enforce clinic specific ... directly supervised. + Assists in the development of the clinic budget. Monitors utilization of staff and supplies and makes appropriate adjustments to meet the… 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
- 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
- CVS Health (Des Moines, IA)
- …Tuesday 6:30am to 5pm in their respective time zone.** As a Care Management Associate you will be supporting comprehensive coordination of medical services including ... supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services.… more