103 Results for

Utilization Management Nurse Jobs in Iowa

Jobs

New!

Estherville, IA2 days ago

$32.50–$48.50

Student Loan Repayment: This Registered Nurse (RN) position may be eligible for Avera’s Student Loan Repayment Program, which helps you pay off your loans and save money. Demonstrates ability to affect the behavior of others to follow the recommended alternatives to care which includes providing thorough instruction and disease management education to patients and/or caregivers as ordered by the physician.

New!

Sioux City, IA2 days ago

We have a diverse range of employee resource groups (ERGs) to encourage employees with similar interests, goals, social and cultural backgrounds, or experiences to come together for professional and personal development, discussion, activities, and peer support. Coordinates inventory/supply management by reviewing monthly inventory count and approving purchase orders for necessary items to ensure cost containment, timely distribution, and competitive pricing.

Larchwood, IA9 days ago

New!

Work At Home, IA4 days ago

$29.10–$62.32 Per Hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

Cedar Rapids, Iowa30+ days ago

The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key role in coordinating the department’s interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-quality health care, optimal clinical outcomes and patient and provider satisfaction. Demonstrates a working knowledge of financial and reimbursement processes to facilitate medical cost management, including best practices, effective utilization of resources, linking clinical and financial aspects of care, and access to care and level of care.

cedar rapids, IA30+ days ago

The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key role in coordinating the department's interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-quality health care, optimal clinical outcomes and patient and provider satisfaction. Demonstrates a working knowledge of financial and reimbursement processes to facilitate medical cost management, including best practices, effective utilization of resources, linking clinical and financial aspects of care, and access to care and level of care.

Des Moines, IA30+ days ago

Remote

Full-time

Applies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.

Iowa City, IA12 days ago

A person in this role will provide consistent and comprehensive information (both in writing and verbally) to providers, clinical teams, patients, external entities and various administrative and management personnel regarding third party, patient billing and customer service activities. The Prior Authorization Revenue Cycle Representative is instrumental in ensuring a seamless experience for both external stakeholders-patients, their families, and insurance representatives-and internal partners, including nurses, technicians, physicians, and other staff at Iowa Health Care.

New!

Dubuque, IA1 day ago

This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and supporting positive behavior change through our Health Coaching and Condition Management programs. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment.

Davenport, IA30+ days ago

As an RN with our Care Coordination Team, you will: • Concurrently and retrospectively ensures the patients progress in the acute episode of care through post discharge and is quality driven while being efficient, cost effective, and safe discharge plan • Works with physicians to facilitate effective and efficient transitions through the process of hospitalization • Works collaboratively with all members of the multi-disciplinary team to ensure patient needs are met and care delivery is coordinated across the continuum, as well as appropriately reimbursed by payers, and that resources are efficiently and effectively utilized • Serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information. MercyOne Genesis serves a 17-county bi-state region of the Quad Cities (Davenport and Bettendorf, Iowa, and Rock Island and Moline, Ill.) metropolitan area and the surrounding communities of Eastern Iowa and Western Illinois.

DES MOINES, IA30+ days ago

Collaborates with the Verification department, Revenue cycle and Medical Eligibility to facilitate the establishment of the correct payer source for patient stay and the documentation of the interactions in the STAR admitting system. General Summary: Responsible for the review of inpatient and outpatient admission records for appropriate admission status at Mercy Medical Center and Mercy West Lakes.

Des Moines, IA30+ days ago

Remote

Full-time

Technical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews.

Waterloo, Iowa11 days ago

Aurelia, IA10 days ago

Accura HealthCare is a Midwest-based healthcare company that manages and operates over 30 skilled nursing care, assisted living, independent living, and memory care communities throughout Iowa, Minnesota, South Dakota, and Nebraska. We're seeking a skilled and compassionate registered nurse to manage and oversee the MDS process and assist our Director of Nursing in leading our team of nursing professionals to ensure the delivery of high-quality care to our residents.

Iowa City, Iowa30+ days ago

Program care is focused on continuity, accountability, relationship based and evidence-based services that reflects a commitment to compassionate, competent care delivered by the interdisciplinary team. With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.   .

Iowa City, IA13 days ago

The role of the Nurse Navigator is to facilitate the progression of care across the continuum for the hospitalized patient through collaboration with the interdisciplinary team which includes but is not limited to patient care staff, providers, patient support, family and community resources. Work collaboratively with Social Work or Care Coordination Team Member to manage social issues that impact the ' transition planning needs, and refer cases of suspected/actual abuse, domestic violence, or neglect to appropriate agencies".

Knoxville, IA10 days ago

ABOUT ACCURA HEALTHCARE: Accura HealthCare is a Midwest-based healthcare company that manages and operates over 50 skilled nursing care, assisted living, independent living, and memory care communities throughout Iowa, Minnesota, South Dakota, and Nebraska. Our MDS Coordinators are passionate about assessing the needs of our residents to provide the support and care they need and promote the physical, mental, emotional, and spiritual well-being of our residents and team members.

Knoxville, IA17 days ago

ABOUT ACCURA HEALTHCARE: Accura HealthCare is a Midwest-based healthcare company that manages and operates over 50 skilled nursing care, assisted living, independent living, and memory care communities throughout Iowa, Minnesota, South Dakota, and Nebraska. Our MDS Coordinators are passionate about assessing the needs of our residentsto provide the support and care they need and promote the physical, mental,emotional, and spiritual well-being of our residents and team members.

IA30+ days ago

Remote

$54,095–$155,538 Per Year

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

Des Moines, Iowa14 days ago

Responsibilities: We are looking for valued employees who will be Champions of the Select Medical Way, which includes putting the patient first, helping to improve quality of life for the community in which you live and work, continuing to develop and explore new ideas, providing high-quality care and doing well by doing what is right. Our hospital is a critical illness recovery hospital committed to providing world-class inpatient post-ICU services to chronic, critically ill patients who require extended healing and recovery.

Council Bluffs, IA20 days ago

It's helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient's needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. About Methodist: Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility.

Council Bluffs, IA20 days ago

Council Bluffs, IA15 days ago

Bachelors of Science in Nursing (BSN) or Master's Degree in Nursing (MSN) from an accredited college of nursing required OR obtained within 5 years from date of hire for nurses with an Associate Degree in Nursing (ADN). About Methodist: Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility.

IA30+ days ago

Remote

Facilitates modifications to clinical documentation through extensive interaction with Physicians, Nursing staff, other patient caregivers, and medical records coding staff to ensure that appropriate reimbursement is received for the level of service rendered to all patients with a DRG based payer (Medicare, Blue Cross, other payors as determined by CDI departmental goals). Facilitates modifications to clinical documentation to ensure that appropriate severity of the patient is documented and to ensure appropriate reimbursement is received for the level of service rendered to all patients with a DRG based payer (Medicare, Blue Cross and others as determined by CDI program goals).

New!

Iowa City, IA3 days ago

An Associate's Degree in Nursing, a Diploma in Nursing, a Baccalaureate Degree in Nursing, Professional Masters of Nursing and Healthcare Practice (MNHP), MSN/Clinical Nurse Leader or a Master's Degree in Nursing (MSN, MA) is required. The University of Iowa Health Care Department of Nursing is seeking a Staff Nurse to perform specific tasks to assist members of the Nursing team in providing patient care under the direct supervision of the Nurse Manager.

Des Moines, IA12 days ago

Responsibilities include improving patient outcomes, reducing unnecessary utilization, optimizing healthcare resources, and partnering with clinical, operational, and external stakeholders to drive high-quality care delivery. This role provides operational oversight, strategic direction, and leadership to ensure coordinated, patient-centered support across the continuum of care.

Sioux Center, IA30+ days ago

The Home Health and Hospice RN is responsible for client care to include direct nursing care, coordination of care, and coordination of services in the home for clients of all ages, unless otherwise specified, in order to assist the client in achieving a maximum level of wellness and independence. • Develops and revises a plan of care based on the initial assessment, continual reassessment of client/family needs, client history, nursing diagnosis, physician orders, expected outcomes, and client goals to include discharge plans when appropriate.

Cherokee, IA30+ days ago

Makes prudent decisions, creates policies and procedures and provides managerial directions and leadership with minimum supervision by providing decisive support to the staff within the department and requires appropriate direction in managing the department. Provides for the collection, analysis and maintenance of data as needed for quality, risk, DNV accreditation, DIA regulations, OSHA guidelines, as required by law or other regulation, or as identified by the organization.

Iowa City, IA30+ days ago

Demonstrated Level III/VI NICU experience • Demonstrated clinical excellence through published articles and/or clinical presentations • Demonstrated experience providing overall medical care and provide medical management for patients in an inpatient setting • Demonstrated experience exercising autonomy in medical decision-making and services provided • Demonstrated experience managing length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care • Professional experience working effectively with individuals from a variety of backgrounds and perspectives • Demonstrated experience in clinical care of pediatrics • Basic Life Support (BLS) certification • Pediatric Advanced Life Support (PALS) certification • DEA License. Understands nursing theory, pathophysiology, and pharmacokinetics with ability to perform patient and family assessment by means of an appropriately comprehensive history and physical examination, develop differential diagnosis based on history, physical and interpretation of appropriately ordered tests and evaluations, develop a plan of care and implement treatment including referrals and prescriptions, and evaluate patient responses to health, illness and treatment.

Davenport, IA19 days ago

$41.35–$62.03 Per Hour

The fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Makes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation.

Sibley, IA30+ days ago

The RNs purpose is to provide quality nursing care to our patients and to supervise the staff working with the RN to coordinate cares with ancillary staff, and to communicate effectively with the physician to ensure patient care. Implements, delegates and supervises nursing care in patient care units by overseeing LPNs, patient care technicians and health unit coordinators.

Windsor Heights, Iowa21 days ago

Actively collaborates with the IDT and Case Manager in managing participant transitions and discharge planning to ensure optimal management of health conditions and prevent readmission to acute care and nursing homes. Coordinates with the IDT to develop a comprehensive, person-centered plan of care for each participant that promotes independence in the community, management of health conditions, and prevention of acute care admissions.

New!

Council Bluffs, IA4 days ago

NMH Cath Lab: 1 year experience in Cardiac Cath Lab, Cardiac Unit, Emergency Room, Post-Anesthesia Care Unit (PACU), Intensive Care Unit (ICU) or Progressive Care unit. Bachelors of Science in Nursing (BSN) or Master's Degree in Nursing (MSN) from an accredited college of nursing required OR obtained within 5 years from date of hire for nurses with an Associate Degree in Nursing (ADN).

Iowa City, IA30+ days ago

The University of Iowa Health Care, department of Internal Medicine is searching for an ARNP to function as an Advanced Practice Nurse and change agent incorporating the primary role of nurse practitioner and the supporting roles of consultant, educator, researcher and administrator to support quality care and positive patient outcomes for adult Pulmonary patients. Inspire and motivate others to high performance by exercising strong stewardship of University resources, setting expectations, measuring success through individual performance evaluations, and driving organizational results.

Des Moines, Iowa30+ days ago

Provide resources, referrals or coordination to the following as needed: Primary Care providers and specialist, Wellness programs, including tobacco cessation, fitness, nutrition or weight management programs, and exercise facilities or classes, Specialized support groups (i.e. cancer or diabetes support groups, NAMI psychoeducation), School supports, Substance use treatment links and treatment, support recovery with links to support groups, recovery coaches, and 12 step program, Housing services. Collaborates with all members of the multi-disciplinary healthcare team to ensure the delivery of high quality, cost-effective care, as evidenced by coordinated transitions of care; achievement of select quality outcome metrics; appropriate utilization of health management programs and resources, within the structure of a patient-centered medical home.

Des Moines, IA30+ days ago

We are looking for valued employees who will be Champions of the Select Medical Way, which includes putting the patient first, helping to improve quality of life for the community in which you live and work, continuing to develop and explore new ideas, providing high-quality care and doing well by doing what is right. Our hospital is a critical illness recovery hospital committed to providing world-class inpatient post-ICU services to chronic, critically ill patients who require extended healing and recovery.

Sioux, IA8 days ago

$3,400–$3,456

By providing frequent feedback and consistently measuring progress, we’ve discovered the recipe for success that’s delivered year over year growth since our first year of business. Provide direct ICU nursing care to critically ill patients in a timely, evidence-based manner.

Iowa City, IA17 days ago

Education Required: An Associate's Degree in Nursing, a Diploma in Nursing, a Baccalaureate Degree in Nursing, Professional Masters of Nursing and Healthcare Practice (MNHP), MSN/Clinical Nurse Leader or a Master's Degree in Nursing (MSN, MA) is required. Experience Requirements: Minimum of six months ED, or critical care (ICU, telemetry inpatient) nursing experience, or a minimum of 12 months RN inpatient hospital nursing experience and/or completion of a senior internship in a level 1, 2, or 3 ED or ICU (within the last year).

New!

Iowa City, IA4 days ago

Education Required: An Associate's Degree in Nursing, a Diploma in Nursing, a Baccalaureate Degree in Nursing, Professional Masters of Nursing and Healthcare Practice (MNHP), MSN/Clinical Nurse Leader or a Master's Degree in Nursing (MSN, MA) is required. Our downtown campus is a 194-bed hospital (located at 500 E Market Street, Iowa City) providing a community-based model of care while directly connected to the expertise, technology, collaboration, and support of our entire health system.

New!

Iowa City, IA6 days ago

Education Required: An Associate's Degree in Nursing, a Diploma in Nursing, a Baccalaureate Degree in Nursing, Professional Masters of Nursing and Healthcare Practice (MNHP), MSN/Clinical Nurse Leader or a Master's Degree in Nursing (MSN, MA) is required. Our downtown campus is a 194-bed hospital (located at 500 E Market Street, Iowa City) providing a community-based model of care while directly connected to the expertise, technology, collaboration, and support of our entire health system.

Iowa City, IA30+ days ago

For additional questions, please contact Penni Berger at penelope-berger@uiowa.eduAdditional InformationClassification Title: Staff NurseAppointment Type: SEIUSchedule: Part-timeWork Modality Options: On CampusCompensationPay Level: 52Contact InformationOrganization: HealthcareContact Name: Penni BergerContact Email: penelope-berger@uiowa.edu. Relocation Assistant available to qualified applicants.https://hr.uiowa.edu/benefitsFor more information about Why Iowa?,clickhereEducation Requirements:· An Associate's Degree, a Diploma in Nursing, a Baccalaureate Degree, Professional Masters of Nursing and Healthcare Practice (MNHP), MSN/Clinical Nurse Leader or a Master's Degree in Nursing (MSN, MA) is required.

Iowa City, IA30+ days ago

Experience Required:Excellent written and verbal communication skills are requiredDemonstrates excellent interpersonal skills with patients/families, nursing staff, and interdisciplinary team members as demonstrated through written and verbal interactionsGeneral computer skills are requiredA minimum of one year RN telemetry experience or one year of RN post-surgical step-down experience is requiredCurrent license to practice nursing in Iowa is required by date of hireDesirable Qualifications:Labor and Delivery ExperienceBaccalaureate Degree in Nursing or Masters Degree in Nursing is highly desiredIf Baccalaureate degree in Nursing is not yet obtained, active enrollment in a BSN program is desirableKnowledge of university policies and proceduresRecent (within the last 3 years) RN Mother/Baby, Pediatric, or Gynecology experience or recent (within the last 24 months) completion of a mother baby internshipPlease attach a resume as part of the application process. Benefits Highlights:Regular salaried position located in Iowa City, IowaFringe benefit package including paid vacation; sick leave; health, dental, life and disability insurance options; and generous employer contributions into retirement plansFor more information about Why Iowa?,clickHERE!Education Required:· An Associate's Degree, a Diploma in Nursing, a Baccalaureate Degree, Professional Masters of Nursing and Healthcare Practice (MNHP), MSN/Clinical Nurse Leader or a Master's Degree in Nursing (MSN, MA) is required.

iowa city, IA30+ days ago

Iowa City, IA17 days ago

Education Required: An Associate's Degree in Nursing, a Diploma in Nursing, a Baccalaureate Degree in Nursing, Professional Masters of Nursing and Healthcare Practice (MNHP), MSN/Clinical Nurse Leader or a Master's Degree in Nursing (MSN, MA) is required. Our downtown campus is a 194-bed hospital (located at 500 E Market Street, Iowa City) providing a community-based model of care while directly connected to the expertise, technology, collaboration, and support of our entire health system.

Iowa City, IA30+ days ago

iowa city, IA30+ days ago

Iowa City, IA30+ days ago

Remote

$63,739–$95,264 Per Year
Part-time

In addition, Medical Case Managers are eligible for bonus and will be provided state-of-the-art technological devices to ensure ready access to CorVel’s proprietary Case Management application, enabling staff to retrieve documents on the go and log activities as they occur. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.

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Utilization Management Nurse Jobs in Iowa

Registered Nurse (RN) Case Manager | Homecare Rock Rapids Avera Health

Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical Care

Registered Nurse (RN) - Case Manager - Homecare Avera Health

Registered Nurse (RN) | Homecare Avera Health

Utilization Management Nurse Consultant CVS Health Corp

RN - Utilization Review Specialist (On-Site) UnityPoint Health

Utilization Review Specialist UnityPoint Health

Utilization Clinical Reviewer TriWest Healthcare Alliance

Revenue Cycle Representative (Prior Authorization) - Patient Access Management (PAM) - Patient Financial Services (PFS) University of Iowa

Bilingual RN Case Manager HealthCheck360

RN - Care Coordination Registered Nurse Trinity Health

Case Manager RN Trinity Health

Program Integrity Clinical Specialist (RN or PA Req'd) TriWest Healthcare Alliance

RN Care Manager UnityPoint Health

ADON/MDS Coordinator - RN - Full-Time Accura HealthCare

RN Lead-GuideLink Center UnityPoint Health

WEO Nurse Case Manager - Downtown Campus University of Iowa

MDS Coordinator - LPN Accura HealthCare

MDS Coordinator - RN Accura HealthCare

Case Manager, Registered Nurse - Fully Remote CVS Health Corp

Case Manager ( RN / RT / SW / LPN ) Select Specialty Hospital - Des Moines

Registered Nurse - OrthoNeuro Oncology - Full Time - Weekend (Friday/Saturday/Sunday) - Nights Nebraska Methodist Health System

Registered Nurse - OrthoNeuro Oncology - Full Time - Weekend (Friday/Saturday/Sunday) - Days Nebraska Methodist Health System

Registered Nurse - Endoscopy - Full Time - Days Nebraska Methodist Health System

Registered Nurse RN - Clinical Documentation Specialist - CDIP or CCDS REQUIRED - Mon - Fri Days - Remote Northeast Georgia Health System Inc

Staff Nurse (80-100%) - Pediatric Cath Lab University of Iowa

Regional Director Care Management-Des Moines UnityPoint Health

Registered Nurse (RN) - Home Health Avera Health

Nurse Manager (Emergency Department) Cherokee Regional Medical Center

NICU Neonatal Nurse Practitioner University of Iowa

Registered Nurse (RN) - Davenport & Bettendorf, IA - $2,000 Sign-On Bonus UnitedHealth Group Inc

RN Avera Health

RN, Clinic Nurse Supervisor Immanuel

Registered Nurse - Cath Lab - Casual - Days Nebraska Methodist Health System

Advanced Registered Nurse Practitioner - Pulmonary (Jefferson Street Clinic) University of Iowa

Registered Nurse Care Coordinator-Eyerly Ball UnityPoint Health

Case Manager ( RN / RT / SW / LPN ) Select Medical Corp

ICU- RN TMS

Staff Nurse - Emergency Medicine - 90% Nights - (1900-0730) - Downtown Campus University of Iowa

Staff Nurse - Home Health - 100% Days (8:00 - 4:30) - HSSB Building University of Iowa

Staff Nurse - Intensive Care Unit - 90% Days (0700-1930) - Downtown Campus University of Iowa

Staff Nurse - OBG, Labor & Delivery - 60% WEO Nights (Fri/Sat) - Downtown Campus University of Iowa

Staff Nurse - 5Telemetry - 90% Nights (1900-0730) - Downtown Campus University of Iowa

Staff Nurse - Maternal Child - 90% Nights - Downtown Campus University of Iowa

Staff Nurse - Emergency Medicine - 60% Nights (1900-0700) - Downtown Campus University of Iowa

Staff Nurse - 80%-100% M-F Days - Radiology - Downtown Campus University of Iowa

Staff Nurse - Emergency Medicine - 70% Days (0700-1930) - Downtown Campus University of Iowa

Staff Nurse - Emergency Medicine - 60%, 90% - (1500-0300 ) - Downtown Campus University of Iowa

Staff Nurse - Emergency Medicine - 90% Nights (1900-0700) - Downtown Campus University of Iowa

RN Case Manager I CorVel Healthcare Corporation

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