- Actalent (Des Moines, IA)
- Utilization Management Nurse Job Description We are seeking a dedicated Utilization Management Nurse to provide members and healthcare providers ... utilization review issues and explore alternative treatment options. + Process utilization management requests using clinical knowledge to interpret medical… more
- CVS Health (Des Moines, IA)
- …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
- CVS Health (Des Moines, IA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST or CST zones.… more
- Molina Healthcare (Cedar Rapids, IA)
- …state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office with internet ... - Flexibility to cover any weekend time if needed Preferred candidate with Utilization Management and leadership experience (Direct Reports) Compact RN license… more
- Humana (Des Moines, IA)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… more
- Trinity Health (Des Moines, IA)
- …the STAR admitting system. ESSENTIAL FUNCTIONS: + Conducts admission review per the Utilization Management Plan to ensure that the hospitalization is approved ... of the change. + Documents in the Medical Record Utilization Management forms accurately to reflect the...AND ABILITIES REQUIRED:** + Current licensure as a registered nurse in the State of Iowa. + Five (5)… more
- Trinity Health (Des Moines, IA)
- …Type:** Full time **Shift:** **Description:** **_Are you an experienced Director of Care Management & Utilization Review looking for an interim assignment? Join ... Des Moines. Operational responsibilities include budgeting, strategic planning, patient care management and integration and achieve organizational goals. Acts as a… more
- Trinity Health (Mason City, IA)
- …+ Works directly with members of care team to effectively ensure appropriate acute utilization management + Interacts with outside review agencies and payors to ... Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case screening, insurance approval,… more
- Molina Healthcare (Des Moines, IA)
- …in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Waverly Health Center (Waverly, IA)
- …nursing unit dealing with providers and patient's records and have functional knowledge of utilization management and case management . c. Must have strong ... of nursing and currently licensed to practice as a Registered Nurse in Iowa. Certification in case management and BSN preferred. b. Minimum of three to five… more