- Evolent Health (Des Moines, IA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance...Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not… more
- Trinity Health (Des Moines, IA)
- …paid malpractice and a 403B match. Essential Job Details: . Lead physician -driven clinical resource utilization program, and work with MercyOne Leadership ... appropriate level of care based on medical necessity, and apply regulatory, health plan, and clinical guidelines in the review of denials . Serve as a resource… more
- Evolent Health (Des Moines, IA)
- …request. + Submitting IT tickets to address barriers to generating cases for clinical review and following the ticket through to completion. + Addressing ... our daily operations this individual also works with our clinical team, which includes our Nurse, Clinical ...to determine if submitted requests require a prior authorization review or redirect as required. + Entering data into… more