• RN - Utilization Review

    UnityPoint Health (Cedar Rapids, IA)
    …Treatmt/Child S + Shift: 0900-1700 + Job ID: 174223 Overview 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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  • 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 (11/04/25)
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  • Care Review Clinician, PA ( RN )

    Molina Healthcare (Sioux City, IA)
    …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
    Molina Healthcare (10/26/25)
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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 (11/19/25)
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  • Clinical Registered Nurse…

    Cognizant (Des Moines, IA)
    …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
    Cognizant (11/15/25)
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  • RN UM Clinical Appeals Nurse Remote

    Molina Healthcare (Des Moines, IA)
    …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...the specific programs supported by the plan such as utilization review , medical claims review ,… more
    Molina Healthcare (11/14/25)
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  • Dialysis Clinical Manager Registered…

    Fresenius Medical Center (Muscatine, 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 (11/13/25)
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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 (09/19/25)
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  • RN , Care Coordination

    Trinity Health (Davenport, IA)
    …Basic Life Support Training Preferred: Certification in Case Management, Professional Utilization Review or Managed Care; DRG/CPT knowledge; Interqual ... Admission/Continued Stay criteria knowledge Licensure/Registration: Registered Nurse in Iowa or Illinois at time of hire, second state required within 1 year.… more
    Trinity Health (11/07/25)
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  • MDS Coordinator - RN

    Accura Healthcare (Lake City, IA)
    …complete, current, and accurate medical records. QUALIFICATIONS: + Current licensure as a Registered Nurse ( RN ) in the applicable state, without ... City has the opportunity to welcome a MDS Coordinator ( RN ) to join our team! Our MDS Coordinators are...use in the evaluation of quality of care and utilization review for the purpose of clinical… more
    Accura Healthcare (11/20/25)
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