• Quality/ Utilization Review…

    George C. Grape Community Hospital (Hamburg, IA)
    Quality/ Utilization Review Nurse Position Summary: The Quality/ Utilization Review Nurse is responsible for evaluating the medical necessity, ... infection control, and payers to resolve care coordination issues. Qualifications: * Education: Registered Nurse ( RN ) license required; BSN preferred. *… more
    George C. Grape Community Hospital (11/25/25)
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  • RN - Utilization Review

    UnityPoint Health (Cedar Rapids, IA)
    …Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a ... coordinating the department's interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-quality health care,… more
    UnityPoint Health (11/07/25)
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  • Medical Review Nurse ( RN…

    Molina Healthcare (Sioux City, IA)
    … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), claims… more
    Molina Healthcare (01/09/26)
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  • Care Review Clinician ( RN )

    Molina Healthcare (Des Moines, IA)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
    Molina Healthcare (01/09/26)
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  • Case Manager, Registered Nurse…

    CVS Health (Des Moines, IA)
    …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
    CVS Health (01/03/26)
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  • RN - Med / Surg

    UnityPoint Health (Anamosa, IA)
    …to provide continuity of care. + Functions under all accountabilities of the Registered Nurse position. + Works with patients/families to identify their goals ... the healthcare team to ensure safe/optimal outcomes for patients/families. Utilization Review + Reviews admission data to...Current licensure in good standing to practice as a Registered Nurse in Iowa. + Must possess… more
    UnityPoint Health (12/17/25)
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  • Dialysis Clinical Manager Registered…

    Fresenius Medical Center (Dubuque, IA)
    …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
    Fresenius Medical Center (12/24/25)
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  • RN - Behavioral Health

    UnityPoint Health (Cedar Rapids, IA)
    …home care. Responsible for case coordination of patients and insurance precertification/ utilization review . Patients served include adult and geriatric. St. ... Coordinates cases with community agencies, referral sources. + Manages utilization review for own patients with insurance...Current licensure in good standing to practice as a Registered Nurse in [type in State]. +… more
    UnityPoint Health (12/19/25)
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  • Bilingual RN Case Manager

    Access Dubuque (Dubuque, IA)
    …also available remotely. **Key Responsibilities:** + Provide telephonic case management and utilization review for assigned consumers. + Develop, implement, and ... Bilingual RN Case Manager **Cottingham & Butler/ SISCO** 1...Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. + **Skills:**… more
    Access Dubuque (12/14/25)
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  • ADON/MDS Coordinator - RN

    Accura Healthcare (Shell Rock, IA)
    …to ensure complete, current, and accurate medical records. QUALIFICATIONS: + Hold current Registered Nurse ( RN ) license with applicable state, without ... join our team! We're seeking a skilled and compassionate registered nurse to manage and oversee the...use in the evaluation of quality of care and utilization review for the purpose of clinical… more
    Accura Healthcare (01/01/26)
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