- Molina Healthcare (Des Moines, IA)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends… more
- Molina Healthcare (Iowa City, IA)
- …The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will ... Ensures Molina is compliant with the coverage determination and appeals process. + Contributes to projects aimed at improving...the pharmacy call center team as delegated by the Manager . + Identifies and implements programs to improve clinical… more
- Sharecare (Des Moines, IA)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
- Access Dubuque (Dubuque, IA)
- …Director on special Zoom requirements or technology needs. + Facilitate Development appeals , maintain mailing lists and track responses. + Support the planning of ... Featured Job TH Ad TH Comments **Similar Jobs** Marketing Program Manager Flexsteel Industries, Inc Marketing & Consumer Insights Intern Flexsteel Industries,… more
- Guardian Life (Des Moines, IA)
- …evaluate more complex medical, financial, non-medical information with little to no manager involvement, and review prior files as developed, to determine the risk ... the entire selection, issue, and administrative process. + Negotiate underwriting appeals with minimal management involvement when collaborating with general agents,… more
- Humana (Des Moines, IA)
- …and assists with the management of psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of prior authorization, clinical ... program; and work closely with the Utilization Management (UM) of services and associated appeals related to adults with mental illness and/or SUD + Leads BH policy… more
- Molina Healthcare (IA)
- …* Provides second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance. * Implements ... (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other… more
- Elevance Health (Adel, IA)
- …Enforcement). + Assists and participates in appeal or fair hearings, member grievances, appeals , and state audits. + Travels to worksite and other locations as ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Sanford Health (IA)
- …advanced knowledge and understanding to process payer rejections. Conducts trend analyses, appeals and resolves low payment or underpaid accounts. Provides input for ... to payers. Ensures accounts are billed in timely manner. Consistently reports to a manager any accounts that cannot be finished in a timely manner. When claims are… more
- Pine Acres Rehabilitation & Care Center (West Des Moines, IA)
- …Title: Cook Department: Dietary & Nutrition Services Supervisor: Dietary Manager Position(s) Supervised: Dietary Aides FLSA Classification: Non-Exempt Revision Date: ... provided by Pine Acres and required by the Iowa Dept. of Inspections & Appeals . v Continuous Education o Attendance of in-service training and meetings as scheduled… more