- Parexel (Des Moines, IA)
- …reproducible research practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable health professional credentials, ... solutions, and ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or anomalies to ensure… more
- 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 (IA)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... **Job Description** **Job Summary** The Medical Review Nurse provides support for medical...our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The… more
- Molina Healthcare (Iowa City, IA)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Access Dubuque (Dubuque, IA)
- Registered Nurse ( RN ) **Sunnycrest...IA UnityPoint Health Finley Hospital Utilization Management Nurse Cottingham & Butler/ SISCO RN New ... + Briefs relieving or supervisory staff on nursing shift developments. + Assists Registered Nurse in utilizing the nursing process which involves assessment,… more
- Fresenius Medical Center (Muscatine, 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 (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)
- …. Is knowledgeable regarding managed care implications - precertification and utilization review procedures. . Provides consultation regarding behavioral health ... License(s)/Certification(s): Current licensure in good standing to practice as a Registered Nurse in [type in State]. Must possess and maintain current Basic… more
- Humana (Des Moines, IA)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review /Quality Management experience + Experience working with MCG ... 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
- Highmark Health (Des Moines, IA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Delaware RN license must be obtained within… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/...20260113 Featured Job TH Ad TH Comments **Similar Jobs** RN - Float Pool Registered Nurse ... 4627707008 Posted On 07/01/2025 Refreshed On 11/23/2025 **Job Overview** ** Utilization Management Nurse ** **Location** : Onsite in... RN - Birth Center Registered Nurse MercyOne Cardiac Care Nurse Medical Associates… 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
- CenterWell (Des Moines, IA)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent… 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 (Davenport, 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 Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
