• Utilization Review Case…

    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
    Trinity Health (05/07/25)
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  • RN Manager Healthcare Services…

    Molina Healthcare (Cedar Rapids, IA)
    …experience. **Preferred License, Certification, Association** Any of the following: Certified Case Manager (CCM), Certified Professional in Healthcare Management ... who be licensed in the state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office… more
    Molina Healthcare (05/10/25)
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  • Bilingual RN Case Manager

    Access Dubuque (Dubuque, IA)
    …ensuring quality outcomes and cost-effective treatment. **Key Responsibilities:** + Provide telephonic case management and utilization review for assigned ... Bilingual RN Case Manager **Cottingham & Butler/ SISCO**...preferred. + **Experience:** Minimum 2 years of clinical practice. Case management or utilization review … more
    Access Dubuque (05/09/25)
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  • Senior Case Manager

    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
    Cardinal Health (04/29/25)
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  • Transplant Care Nurse RN - Stem Cell, Bone Marrow…

    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
    Highmark Health (04/25/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Davenport, IA)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified… more
    Molina Healthcare (05/10/25)
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  • RN-Home Care Skilled Nursing

    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 (05/01/25)
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  • Mgr Sales Development

    Lumen (Des Moines, IA)
    …world and shape the future. **The Role** As an Inside Sales Lead Generation Manager you're tasked with leading a group of highly motivated and talented Sales ... the key to success of Lumen. The Lead Generation Manager must be passionate about sales and building a...acquisition and penetration experts + Run weekly dashboards/reports to review with SDR leadership + Provide mentorship and training… more
    Lumen (05/09/25)
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  • Senior PBM Pricing Analyst

    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
    Access Dubuque (05/01/25)
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  • Oncology Pharmacist, Medical Pharmacy

    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
    Evolent (05/01/25)
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