- Evolent (Des Moines, IA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Centene Corporation (Des Moines, IA)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies… more
- Cognizant (Des Moines, IA)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. + Medical Necessity Reviews can… more
- Elevance Health (West Des Moines, IA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role enables associates to work virtually ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Clinical Fraud Investigator II** is responsible… more
- BioLife Plasma Services (Des Moines, IA)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife ... of laboratory test results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works under the guidance of… more
- Iowa Department of Administrative Services (Mitchellville, IA)
- …Boards of Nursing is available at theNurse Licensure Compact (https://nursing.iowa.gov/practice/ nurse -licensure-compact) Review the provisions of the statute ... Registered Nurse Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/5147520) Apply Registered Nurse...have the opportunity to work closely with other nurses, medical practitioners and a multidisciplinary team to address physical… more
- Mary Greeley Medical Center (Ames, IA)
- …the appropriate level of care setting. + Coordinates all communications and review requirements for external agencies third party payers and Executive Health ... the resolution of identified problems. Presents the results to the Patient Care Review Committee and other groups as appropriate. + Coordinates denial of services… more
- CenterWell (Des Moines, IA)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... to work every other holiday.** The **Care Manager, Telephonic Nurse ** helps to ensure optimal continuity of care for...Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services +… more
- Datavant (Des Moines, IA)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Trinity Health (Des Moines, IA)
- …care areas, may perform or demonstrate patient care tasks which may expose the clinical nurse to infectious or communicable disease, or possibility of injury ... safe, effective, and culturally competent care for patients with acute medical and surgical conditions. Through evidence-based practice, utilizes critical thinking… more
- Surgery Care Affiliates (West Des Moines, IA)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Humana (Des Moines, IA)
- …effectively communicate a meaningful narrative with those findings + Proven ability to perform clinical reviews and review medical records + Ability to ... of our caring community and help us put health first** The Senior Clinical Medical /Financial Risk Evaluation Professional is responsible for supporting the… more
- Select Medical (Des Moines, IA)
- …as a resource for healthcare professionals through fostering relationships within medical facilities. With clinical expertise and problem-solving skills, you'll ... of thousands of patients every day. **Responsibilities** **What a Clinical Liaison Does** At Select Medical , we...of care. **Qualifications** **What we're looking for in a Clinical Liaison** **Required Skills:** + Registered Nurse … more
- CenterWell (Des Moines, IA)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Aveanna Healthcare (West Des Moines, IA)
- …* Achieve clinical and metrics provided by the executive team * Review weekly/monthly clinical performance reports to assure nursing expectations are being ... Nurse within the last 5 years; in a clinical care setting preferred * Current CPR accredited by...including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate. As an employer… more
- Oracle (Des Moines, IA)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- BrightSpring Health Services (Johnston, IA)
- …Help clinicians grow professionally and create a strong team culture. As a RN Clinical Supervisor You will: + Review new patient referrals and determine care ... Our Company Hospice of the Midwest Overview RN Clinical Supervisor Office Location: 9249 Northpark Drive, Johnston...and organizational goals. Benefits and Perks for You! + Medical , Dental, Vision insurance + Health Savings & Flexible… more
- Molina Healthcare (Des Moines, IA)
- …, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more
- Molina Healthcare (Des Moines, IA)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Fresenius Medical Center (Des Moines, IA)
- …direct patient care staff on appropriate programs under the supervision of a nurse . + Provides developmental support to applicable clinical and facility staff. ... for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training...Related** + Participates in the recruitment process for new clinical staff + Assists with clinical orientation… more