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Company Contact Info

  • 3737 Woodland Avenue
    Suite 200
    West Des Moines, IA 50266

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Utilization Management Nurse - Registered Nurse

Palmer Group • West Des Moines, IA

Posted 1 month ago

Job Snapshot

Contractor
Travel - None
Experience - At least 3 year(s)
Degree - 4 Year Degree
$28.00 - $32.00 /Hour
Consulting
Health Care

Job Competition

6

Applicants

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Job Description

Our Des Moines client is seeking a Utilization Management Nurse - Registered Nurse to join their team on a long-term contract basis. The qualified candidate will utilize clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. Start a conversation with Emily if this is the right opportunity for you.

Responsibilities:

  • Review clinical information and policies and determine whether services can be approved or will eventually be denied
  • Manage network participation, care with specialty networks, care with providers and transfer to alternative levels of care using knowledge of benefit plan
  • Recommend services utilizing care alternatives available within the community and nationally
  • Identify potentially unnecessary services and care delivery settings and recommend alternatives if appropriate
  • Examine clinical programs to identify members for specific case management and/or disease management activities or intervention by utilizing established screening criteria
  • Conduct admission review, post-discharge calls and discharge planning
  • Collaborate with healthcare providers in reviewing actual and proposed medical care and services against established client coverage guidelines review criteria

Job Requirements

Minimum Qualifications:

  • Flexibility, professionalism, and clinical knowledge are critical
  • Active RN license
  • 3+ years of clinical experience in a variety of clinical settings (operating room, acute care, med surg)
  • Strong computer skills with Microsoft Office, electronic charting and documentation systems
  • Familiarity with ICD-9, HCPC, CPT

Preferred Qualifications:

  • Bachelor's degree in nursing
  • Certified Professional Coder (CPC) or UM Certification
  • Experience in utilization management in a clinical or health insurance setting with a diverse medical background
  • Experience interpreting health care benefits


Hours: 8:00AM-5:00PM Monday-Friday


Palmer Group offers our valued temporary and contract employees, Health, Dental, and Vision insurance the 1st of the month after 60 days of employment. These plans are fully compliant with the Affordable Care Act standards. 

Job ID: MAS29346
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