- Molina Healthcare (Des Moines, IA)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Highmark Health (Des Moines, IA)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Veterans Affairs, Veterans Health Administration (Des Moines, IA)
- …the Referral Coordination Team (RCT) at VA Central Iowa Health Care System (VACIHCS). RN will review patient community care eligibility and medical necessity of ... Summary The Central Iowa VA is hiring for a RN assigned to Community Care. The positions is open...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Molina Healthcare (Des Moines, IA)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- CVS Health (Des Moines, IA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… more
- Molina Healthcare (Des Moines, IA)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more
- Guardian Life (Des Moines, IA)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Mainstream Living Inc (Des Moines, IA)
- …Services, psychology, sociology, health care administration, public administration, or be a Registered Nurse in Iowa. Experience: Behavioral Health and/or Human ... have the ability to plan and follow a prescribed budget which requires the utilization of basic and complex mathematical skills. Must have the ability to solve… more