- CenterWell (Des Moines, IA)
- …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- Molina Healthcare (Sioux City, IA)
- …**Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services ... are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through… more
- CVS Health (IA)
- … Nurse Consultant** Fully Remote- WFH- 8A-5P in EST or CST **Position Summary** UM Nurse Consultant Utilizes clinical experience and skills in a ... options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- Evolent (Des Moines, IA)
- …coordinating with UM staff to ensure timely and accurate communication of clinical decisions. + Responsible for completion of UM projects and participation ... the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and… more
- Evolent (Des Moines, IA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member...medical management activities in a managed care environment + UM /UR experience + Clinical experience in Oncology,… more
- Humana (Des Moines, IA)
- …us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation… more
- Highmark Health (Des Moines, IA)
- …experience, or provider operations and/or health insurance experience + 1 year in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year ... panel of members that range in health status/severity and clinical needs; and assesses health management needs of the...RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or… more
- Trinity Health (Des Moines, IA)
- **Employment Type:** Full time **Shift:** **Description:** The UM Lead is responsible for overseeing day-to-day activities within the Utilization Management ( UM ) ... escalation for problem-solving. This role ensures effective leadership and delegation of daily UM activities and workflows. The UM Lead is also responsible for… more
- Molina Healthcare (IA)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that… more
- Molina Healthcare (Sioux City, IA)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... and align with established clinical guidelines, insurance policies, and regulations - ensuring members...the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least… more