• Clinical Appeals Nurse (RN)

    Molina Healthcare (Sioux City, IA)
    …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...denied cases in which a formal appeals request has been made or upon request by… more
    Molina Healthcare (08/15/25)
    - Related Jobs

  • Appeals Registered Nurse

    Evolent (Des Moines, IA)
    …Stay for the culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent… more
    Evolent (08/08/25)
    - Related Jobs

  • Infusion Referral Nurse - REMOTE

    Prime Therapeutics (Des Moines, IA)
    …drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description** Under supervision, is responsible for performing referral ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt… more
    Prime Therapeutics (07/24/25)
    - Related Jobs

  • Med/Surg Tech .6 FTE 1st shift

    Waverly Health Center (Waverly, IA)
    …on the Iowa Direct Care Worker Registry (Iowa Department of Inspections and Appeals Health Facilities Division). Completion of Nurse Aide II course preferred. ... scope of practice under the direction of a Registered Nurse . MINIMUM QUALIFICATIONS Education, Experience, and Training + Must...preferred. + Must have successfully completed a minimum of Nurse Aide I course and competency exams and be… more
    Waverly Health Center (08/26/25)
    - Related Jobs

  • Health Facilities Surveyor - Hospitals

    Iowa Department of Administrative Services (State Of Iowa, IA)
    …IA Job Type Full-time Job Number 26-00485 Agency 427 Department of Inspections, Appeals & Licensing Opening Date 08/21/2025 Closing Date 9/4/2025 11:59 PM Central ... + Questions Job Description The Iowa Department of Inspections, Appeals & Licensing (DIAL) is seeking a motivated and...educational program in professional Nursing and registration as a nurse or graduation from an accredited college or university… more
    Iowa Department of Administrative Services (08/22/25)
    - Related Jobs

  • Clinical Manager, Home Health -- RN

    WesleyLife (Urbandale, IA)
    **Description** **A Day in the Life** + Support the Nurse Case Managers leading teams of nurses, physical or occupational therapy team members, and home care aides. ... + Retain responsibility for onboarding and education, delegating tasks to the Nurse Case Managers in coordination with the Clinical Educator. + Provide ongoing… more
    WesleyLife (08/13/25)
    - Related Jobs

  • Medical Director

    Molina Healthcare (Davenport, IA)
    …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the 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 (08/20/25)
    - Related Jobs

  • 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 ... LPN or RN MercyOne Surgical Services RN - Registered Nurse MercyOne Patient Access Rep - Patient Services -...- Full Time MercyOne Surgical Services RN - Registered Nurse MercyOne Customer Service Representative Cottingham & Butler/ SISCO… more
    Access Dubuque (08/26/25)
    - Related Jobs

  • Director, Physician Leadership - Medical Directors…

    Humana (Des Moines, IA)
    …responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare members. You will also ... : Characterize the impactable drivers of prior authorization and look at appeals rate with denials and overturns. Deliver the upmost consistent medical director… more
    Humana (08/21/25)
    - Related Jobs

  • RN Clinical Integration Specialist Full Time

    Trinity Health (Des Moines, IA)
    …for Medicare and Medicaid Services (CMS), Iowa Department of Inspections and Appeals (IDIA), The Joint Commission (TJC),etc.), in conjunction with the hospital's ... Full-Time Day Shift **General Requirements:** + Iowa licensure as a Registered Nurse . + Member of a professional healthcare organization. **Education:** + High… more
    Trinity Health (08/08/25)
    - Related Jobs