• Member Services Representative

    Access Dubuque (Dubuque, IA)
    …to internal processing guidelines. + Assist in review and resolution of complaints, appeals and grievances as needed. + Complete all additional assigned projects ... and duties. **Knowledge, Skills and Abilities:** _Experience:_ One to three years of similar or related experience. _Education:_ High school diploma or GED required. _Other Skills:_ Excellent telephone presence. Familiar with Microsoft Office applications,… more
    Access Dubuque (08/26/25)
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  • Mgr, Employee Advocacy

    UnityPoint Health (Des Moines, IA)
    …employee relations problems, such as working conditions, disciplinary actions, and employee appeals and grievances . + Responds effectively to employee relations ... queries, including questions on policies and practices. + Serve as Common Ground facilitator + Recognizes patterns and anticipates employee-related issues; develops, recommends, and initiates appropriate steps for resolution in accordance with policies and… more
    UnityPoint Health (08/13/25)
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  • Medical Director, Clinical Services

    Highmark Health (Des Moines, IA)
    …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with… more
    Highmark Health (07/29/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Iowa City, IA)
    …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
    Molina Healthcare (08/08/25)
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  • LTSS Service Coordinator - Eastern Iowa

    Elevance Health (IA)
    …Services, Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. + Travels to worksite and other ... locations as necessary. **Minimum Requirements:** + Requires BA/BS degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background. + Specific… more
    Elevance Health (08/14/25)
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