- Mainstreetwashington (Waterloo, IA)
- …accreditation standards, and all aspects of patient care including quality assurance, utilization review, risk management , cost containment, total quality ... physician access and service, quality assurance, quality improvement, and clinical resource management Demonstrated successes delivering organizational outcomes… more
- Humana Inc (Des Moines, IA)
- …Knowledge of the managed care industry, Integrated Delivery Systems, health insurance, or clinical group practice management Utilization management ... put health first The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- UnityPoint Health (Cedar Rapids, IA)
- …changes for compliance + Documents the case management plan to include: clinical needs, barriers to quality care, effective utilization of resources and ... medical cost management , including best practices, effective utilization of resources, linking clinical and financial...team-oriented approach + Ability to give work direction to non- clinical staff + Use of usual and… more
- George C. Grape Community Hospital (Hamburg, IA)
- …infection control outcomes. * Education & Collaboration: o Educate clinical staff on documentation requirements, utilization management processes, and ... infection control standards. o Serve as a liaison between clinical teams, case management , infection control, and payers to resolve care coordination issues.… more
- Access Dubuque (Dubuque, IA)
- …and proficiency in case management for provision of care, clinical expertise, documentation, utilization effectiveness, patient experience and quality ... competencies throughout the orientation period. * Validates the ongoing competencies of current clinical staff as directed by the Ambulatory Clinical … more
- UnityPoint Health (Dubuque, IA)
- …and proficiency in case management for provision of care, clinical expertise, documentation, utilization effectiveness, patient experience and quality ... orientation period. * Validates the ongoing competencies of current clinical staff as directed by the Ambulatory... management skills. * Ability to critically think and make clinical decisions based on verbal and written… more
- Highmark Health (Des Moines, IA)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- Fresenius Medical Center (Dubuque, IA)
- …courses and that licensures/certifications are current. + Provides support for all clinical staff members at regular intervals and encourages professional ... eligibility for treatment. + Reports changes in patient status regarding any clinical , insurance, or travel and transportation issues. STAFF : + Participates… more
- Trinity Health (Newton, IA)
- … responsibilities as assigned. Serves as the department's Clinical Education Coordinator conducting needs assessments, objective development, orientation ... approach. + Provides consultation upon request in area of clinical expertise to other nursing staff or...may represent the department on hospital committees or attend management meetings. **CARE COORDINATION** + Plans resource utilization… more
