- Molina Healthcare (Iowa City, IA)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Banner Health (IA)
- …make Banner Health the best place to work and receive care. As an Associate Manager of RN Denials Management, you will be an integral part of leadership within the ... in payer clinical denials. Collaborates with Care Coordination, physician, Utilization Review, and other internal/external departments to overturn and/or reduction… more
- Elevance Health (West Des Moines, IA)
- **Provider Relationship Account Manager , Iowa Market** **Location: Iowa** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering ... is granted as required by law. The **Provider Relationship Account Manager ** is responsible for providing quality, accessible and comprehensive service to… more
- Access Dubuque (Dubuque, IA)
- Clinical Account Manager **MedOne Pharmacy Benefit Solutions** 1 Positions ID: 3543661 Posted On 09/02/2025 Refreshed On 10/07/2025 **Job Overview** **Position ... Overview:** The Clinical Account Manager will support all clinical aspects of the business...process, including communicating clinical rationale, formulary therapeutic alternatives, and appeals process to members + Performs duties related to… more
- Molina Healthcare (Des Moines, IA)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure ... most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-… more
- Molina Healthcare (Des Moines, IA)
- …modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Provides support for medical claim… more
- Sharecare (Des Moines, IA)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
- Molina Healthcare (IA)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Elevance Health (Adel, IA)
- …chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports. + At the direction of ... and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation supporting and… more
- 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