• Medical Claim Review…

    Molina Healthcare (Cedar Rapids, IA)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
    Molina Healthcare (09/06/25)
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  • Nurse Auditor

    Actalent (West Des Moines, IA)
    …requires auditing and pricing a wide variety of claim types and identifying claims requiring further review . The Nurse Auditor will also maintain ... procedures. + Audit and price a diverse range of claim types. + Identify claims with inaccurate...(RN) license required. + 3+ years of experience in medical record review , billing, and auditing. +… more
    Actalent (08/30/25)
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  • Nurse Auditor

    Actalent (West Des Moines, IA)
    …understanding of standard medical coding, including CPT, ICD-10, and HCPCS. The Nurse Auditor is responsible for adjudicating claims to comply with client ... claims , auditing and pricing a wide variety of claim types, and ensuring compliance with departmental and company...(RN) license required. + 3+ years of experience in medical record review , billing, and auditing with… more
    Actalent (09/03/25)
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  • Utilization Management Nurse

    Actalent (Des Moines, IA)
    Job Title: Post Review Nurse - Utilization Management Job...and claims assessments using InterQual criteria and medical policy. + Review medical ... Description We are seeking a dedicated and skilled Post Review Nurse to join our Utilization Management...role, you will perform timely utilization management reviews and claims assessments, ensuring adherence to medical policy… more
    Actalent (09/05/25)
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  • UM Nurse - Remote

    Actalent (Des Moines, IA)
    …utilization management reviews and claims assessments using InterQual criteria. + Review medical records for suspended claims and provider inquiries ... Job Title: Post Review Nurse - Utilization Management Job...role, you will perform timely utilization management reviews and claims assessments using InterQual criteria and medical … more
    Actalent (09/05/25)
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  • Utilization Management Nurse

    Actalent (Des Moines, IA)
    Job Title: Post Review Nurse - Utilization Management Job...and claims assessments using InterQual criteria and medical policy. + Review medical ... Description We are seeking a diligent and detail-oriented Post Review Nurse to perform timely utilization management reviews and claims assessments. This… more
    Actalent (09/04/25)
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  • Case Manager, Registered Nurse - Fully…

    CVS Health (Des Moines, IA)
    …within time zone of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.… more
    CVS Health (08/15/25)
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  • UM Behavioral Health Nurse

    Humana (Des Moines, IA)
    …action. + Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation for Quality Reviews ... the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical records sent from… more
    Humana (09/09/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Sioux City, IA)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
    Molina Healthcare (08/15/25)
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  • Clinical Fraud Investigator II - Registered…

    Elevance Health (West Des Moines, IA)
    …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
    Elevance Health (09/11/25)
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