- Trinity Health (Mason City, IA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include ... members of care team to effectively ensure appropriate acute utilization management + Interacts with outside review ...acute utilization management + Interacts with outside review agencies and payors to inform them of extended… more
- Molina Healthcare (Sioux City, IA)
- …(RN) or State Clinical Social Worker/Counseling (or related field) License Certified Case Manager (CCM), Utilization Management Certification (CPHM), ... Responsible for the development, implementation, and delivery of training curriculum for Utilization Management, Case Management, and LTSS staff. Leads and… more
- Molina Healthcare (Cedar Rapids, IA)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
- Cardinal Health (Des Moines, IA)
- …get life-changing therapies to patients who need them-faster.** **_Responsibilities_** The Senior Case Manager supports patient access to therapy through patient ... develop and execute effective solutions. + Provide guidance and training to junior case managers on best practices in case management, patient interaction, and… more
- GAF (Cedar Rapids, IA)
- …this roof, we protect what matters most. **Team Summary** The Maintenance Excellence Manager is a key member of the Corporate Reliability & Maintenance team and ... with the site Planners/Schedulers/Supervisors and can tailor site-specific needs on a case -by- case basis. + Works with supporting organizations on a unified… more
- Molina Healthcare (Des Moines, IA)
- …that support one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... of care and quality of Molina services provided. * Functions as hands-on manager responsible for supervision and coordination of daily activities. * Ensures adequate… more
- Highmark Health (Des Moines, IA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. ... industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans… more
- Access Dubuque (Dubuque, IA)
- …for an ongoing interdisciplinary assessment of the patient when they are the case manager . + Performs initial and comprehensive assessments on all patients ... to CMS guidance and agency policies and procedures. + Participates in clinical review of records to monitor quality and accuracy, appropriate utilization ,… more
- Access Dubuque (Dubuque, IA)
- …insights and solutions. **About MedOne:** MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, ... at the most affordable price. **What You'll Do:** + Review and monitor client and pharmacy contracts and our...eg, to hit financial targets, predict the impact of pricing/ utilization changes, and/or determine the size of risks/opportunities +… more
- Evolent (Des Moines, IA)
- …Oncology clinical Q&As for provider portal, prior authorizations, lists, regimens, scope diagnoses, case review and related activities. + Review of Carepro ... value- based care and initiatives within pathway, policy, and beyond utilization management solutions. + Introduce innovative initiatives supported with evidence and… more