- Humana (Des Moines, IA)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills ... medical services and/or benefit administration of post-acute determinations. The Manager , Utilization Management Nursing...to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in IL, WI, MN, SD, ND, IA,… more
- Evolent Health (Des Moines, IA)
- …others. **Collaboration Opportunities** : The Lead Nurse of Utilization Management is responsible for assisting the UM Manager in supervising the ... operational productivity of the Utilization Management nurses by implementing and maintaining an efficient and...department. The UM Lead, in collaboration with the UM Manager and Director, ensures compliance with all regulatory standards… more
- Select Medical (Des Moines, IA)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... **Overview** **Critical Illness Recovery Hospital** **Case Manager ** _Requires a current licensure in a clinical...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- Elevance Health (West Des Moines, IA)
- ** Nurse Reviewer I** **Location:** Within 50 miles of...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Prime Therapeutics (Des Moines, IA)
- …+ Clinical and Quality oversight for this program is provided by the Manager , Patient Programs. **Responsibilities** + Registered Nurse (RN). + 5 years ... post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Magellan Credentialing criteria.… more
- Trinity Health (Des Moines, IA)
- …Full time **Shift:** **Description:** As an integral member of Mercy One's PHSO Care Management department, the Manager of Post Acute and Transition Care ... team members across the network. In addition, the Manager is responsible for the building, management ,...PHSO strategies and infrastructure necessary to effectively manage costs, utilization and quality associated with risk contracts in the… more
- CVS Health (Des Moines, IA)
- …Abuse, Maternity, Transplant or Medical/Surgical **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or ... time zone.** + This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients +… more
- Trinity Health (Des Moines, IA)
- …systems to insure effective communications along the continuum. . Collaborates with Utilization Management staff regarding payer information, level of care and ... others. . Other duties as assigned by CIN Director/Care Management /Social Services Manager . MINIMUM KNOWLEDGE, SKILLS AND...a current or compact state license as a Registered Nurse issued/defined by the State of Iowa . Three… more
- Huron Consulting Group (Des Moines, IA)
- …it promotes a culture of respect, unity, collaboration, and personal achievement. As a Manager , you will have the unique ability to specialize in certain areas that ... talent, training, supervising, coaching/mentoring, and providing feedback through performance management + Facilitate communication and collaboration between all key… more
- Sharecare, Inc. (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...Patient Care Technician (PCT) + Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager +… more
- Elevance Health (West Des Moines, IA)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and procedures. + Investigates potential… more