- 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 (IA)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment ... At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS),… more
- Centene Corporation (Des Moines, IA)
- …concurrent review findings + Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members + ... overall health and appropriate level of care + Reviews quality and continuity of care by reviewing acuity level,...care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Access Dubuque (Dubuque, IA)
- …PRN Neonatal Nurse Practitioner - Dubuque, IA UnityPoint Health Finley Hospital Utilization Management Nurse Cottingham & Butler/ SISCO Neonatal - Nurse ... Cardiac Care Nurse **Medical Associates** 1 Positions ID: oF2bxfw9 Posted...patient health care data, perform diagnostic testing, treatments, and review medical records and confer with physician/mid-level providers to… more
- Access Dubuque (Dubuque, IA)
- …& Butler/ SISCO Account Manager - Health and Wellness Cottingham & Butler/ SISCO Utilization Management Nurse Cottingham & Butler/ SISCO Neonatal - Nurse ... Employee Health Nurse **Medical Associates** 1 Positions ID: oFIMyfwr Posted...tracking, recordkeeping, and reporting, meeting preparations/follow up, and policy review and writing. This will also lead into training… more
- Humana (Des Moines, IA)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review / Quality Management experience + Experience working ... a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments… 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
- Fresenius Medical Center (Muscatine, 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)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… 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 (Iowa City, 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
- Molina Healthcare (Davenport, IA)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Assesses services for… more
- Highmark Health (Des Moines, IA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… 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
- Datavant (Des Moines, IA)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… 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
- UnityPoint Health (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
- Accura Healthcare (Knoxville, IA)
- …and data from health records, and personalized assessments for use in the evaluation of quality of care and utilization review for the purpose of clinical ... Join the Accura Healthcare of Knoxville team-proud recipients of AHCA's Bronze National Quality Award. JOB HIGHLIGHTS + Full Time + On-Call rotation; 1 day weekly,… more
- Access Dubuque (Dubuque, IA)
- …SISCO Experienced Sales Executive - Risk Management Cottingham & Butler/ SISCO Utilization Management Nurse Cottingham & Butler/ SISCO Bilingual Member Services ... of data; and to support delivery of the highest quality of customer service as a point of contact...into the payroll and time and attendance system. + Review reports for claim accuracy; processes and balances colleague… more