- George C. Grape Community Hospital (Hamburg, IA)
- Quality / Utilization Review Nurse Position Summary: The Quality / Utilization Review Nurse is responsible for evaluating the medical ... years of clinical nursing experience (acute care preferred). o Prior experience in utilization review , case management, quality improvement, and infection… more
- Molina Healthcare (Sioux City, IA)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- Centene Corporation (Des Moines, IA)
- …concurrent review findings + Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members + ... overall health and appropriate level of care + Reviews quality and continuity of care by reviewing acuity level,...care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- CVS Health (Des Moines, IA)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Evolent (Des Moines, IA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Highmark Health (Des Moines, IA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... in achieving their personal health goals. Will work with providers to insure quality and appropriate care is being delivered in a timely manner. **ESSENTIAL… more
- Urbandale Community School District (Urbandale, IA)
- Job Details Job ID: 5227365 Job Description JOB TITLE - Substitute Nurse PURPOSE OF THE POSITION - We are seeking qualified individuals who are eager and available ... to serve as a substitute nurse . School nursing, a specialized practice of nursing, protects...health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that… more
- Evolent (Des Moines, IA)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- UnityPoint Health (Waterloo, IA)
- …patient population, ensuring that adequate discharge plans are in place and completing utilization management and quality review activities. Care is provided ... role in the multidisciplinary effort to identify and deliver quality and cost-efficient healthcare to patients. While the role...family. + Communicates the discharge plan to the primary nurse and healthcare team through verbal updates and handoff… more
- Fresenius Medical Center (Dubuque, IA)
- …As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility ... Manages the operations of the clinic, including costs, processes, staffing, and quality standards. + Provides leadership, coaching, and development plans for all… more