• RN Medical Review Nurse Remote

    Molina Healthcare (IA)
    …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department . We are seeking a Registered Nurse with ... modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides… more
    Molina Healthcare (12/03/25)
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  • LTSS Network Relations Consultant, West Iowa

    Elevance Health (Carroll, IA)
    …resolution through direct contact with providers, claims, pricing and medical management department . + Identifies and reports on provider utilization patterns ... provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution. May be responsible for coordinating non-negotiated… more
    Elevance Health (12/10/25)
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  • Chief Psychiatrist - Behavioral Health Medical…

    Humana (Des Moines, IA)
    …implementation of the Quality Management (QM) program; and work closely with the Utilization Management (UM) of services and associated appeals related to adults ... strategic management of behavioral and physical health services, including Utilization Management (UM), Quality Improvement, and value-based payment programs. The… more
    Humana (10/23/25)
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