- Molina Healthcare (Sioux City, IA)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports… more
- CenterWell (Des Moines, IA)
- …DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- CenterWell (Des Moines, IA)
- …procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- Molina Healthcare (Sioux City, IA)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides… more
- Fresenius Medical Center (Algona, IA)
- …**LICENSES:** + HighSchooldiplomaorG.E.D. required. + Must meet Center for Medicaid/ Medicare Services ( CMS )-approved state and/or national certification ... dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance… more
- MPAC Healthcare (Cedar Rapids, IA)
- …entrepreneurial spirit accompanied by strong medical knowledge, understanding of documentation ( CMS , Medicare , Medicaid) and nursing home/ hospital facility ... an active, lead member on an interdisciplinary team of physicians and nurse practitioners addressing residents' emotional, social, and psychological needs. * You… more
- MPAC Healthcare (Huxley, IA)
- …entrepreneurial spirit accompanied by strong medical knowledge, understanding of documentation ( CMS , Medicare , Medicaid) and nursing home/ hospital facility ... MPAC Healthcare, we are building a company to thrive in tomorrow's healthcare system . With a focus on purposeful, quality care, our comprehensive services are… more
- Fresenius Medical Center (Dubuque, IA)
- …specific certification as defined by Center for Medicaid/ Medicare ( CMS )Allappropriatestatelicensure,education,andtraining(ifany) required. + Demonstrated ... dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance… more
- Trinity Health (Des Moines, IA)
- …system strategies, regulatory and accrediting body requirements (ie, Centers for Medicare and Medicaid Services ( CMS ), Iowa Department of Inspections and ... outcomes. + Assists the manager in achieving the best outcomes aligned to CMS , pay for performance programs (including those aligned to commercial carriers) and TJC… more
- CenterWell (Urbandale, IA)
- …review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently ... driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care,… more