Top 37 Utilization management Jobs in Waverly, Ia

Patient Care Coordinator
VGM Group, Inc —Waterloo, IA
- Full-time
- Hybrid work
- HIPAA
- Office
- High school diploma or GED
EMT, Paramedic or LPN (PRN)
Medcor Inc —Cedar Falls, IA
- PRN
- Mid-level
- 2 years
Quick Apply
Pediatric/NICU RN Unit Manager
MercyOne —Waterloo, IA
- 8 hour shift
- Nursing
- RN License
- Inpatient
Quick Apply
Patient Care Tech - Med/Surg .6 FTE 3rd shift
Waverly Health Center —Waverly, IA
- Part-time
- Hospital
- Computer literacy
- Inpatient
Program Director
Healogics —Waterloo, IA
- $88,400 - $116,400 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Nursing Informaticist & Quality Specialist 1.0 FTE 1st shift
Waverly Health Center —Waverly, IA
- Full-time
- Nursing
- RN License
- Hospital
Registered Nurse
Waverly Health Center —Waverly, IA
- Full-time
- Nursing
- Surgery
- RN License
Board-Certified General Medicine Provider
Dane Street, LLC —Waterloo, IA
- Contract
- Medicine
- BC/BE
- Mid-level
Quick Apply
RN Care Coordinator Acute Care
UnityPoint Health —Waterloo, IA
- Part-time
- Acute care
- Nursing
- RN License
- Paid holidays
- Disability insurance
10d
Registered Nurse, Emergency Department, PRN
Waverly Health Center —Waverly, IA
- Part-time
- Nursing
- Surgery
- RN License
Labor & Delivery RN .75 FTE Weekend Package, Days
Waverly Health Center —Waverly, IA
- Part-time
- Nursing
- Surgery
- RN License
Hospitalist Nurse- Palliative Care
UnityPoint Health —Waterloo, IA
- 8 hour shift
- CPR Certification
- Nursing
- Skilled nursing facility
- Paid holidays
- Disability insurance
Labor & Delivery RN 0.3 FTE, 7p-7a
Waverly Health Center —Waverly, IA
- 12 hour shift
- Acute care
- Nursing
- Surgery
Labor and Delivery Registered Nurse, .6 FTE, 1st shift
Waverly Health Center —Waverly, IA
- Part-time
- Acute care
- Nursing
- Surgery
Market Chief Medical Officer - Waterloo
UnityPoint Health —Waterloo, IA
- Full-time
- Medicine
- 7 years
- Hospital
Registered Nurse, Labor & Delivery .75FTE Weekend Package, 3rd shift
Waverly Health Center —Waverly, IA
- Part-time
- Acute care
- Nursing
- Surgery
Rehab Director
Blue Stone Therapy —New Hampton, IA
- Full-time
- Skilled nursing facility
- Physical & Rehabilitation Medicine
- Mid-level
- Health savings account
- Paid holidays
Quick Apply
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply
Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply
Complex Care Manager RN-Western MA (Hybrid)
WellSense Health Plan —United States
- $74,000 - $107,000 a year
- Full-time
- Hybrid work
- Background check
- School experience
- Nursing
- Health insurance
- Dental insurance

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Patient Care Coordinator

VGM Group, Inc -
Waterloo, IA

Apply Now

Job Details

Full-time

Qualifications

Health insurance authorizations
Completing CE credits
Insurance products customer support
Patient question and concern management
Medical documentation
Email customer support
Medicare
DME
Medical software
Phone communication
Medical insurance coverage verification
Intake
Customer order taking
Shipment tracking for distribution operations
Patient demographics
HIPAA
Medical coding guidelines
Patient complaint handling
Care documentation
Durable medical equipment (DME) coordination
High school diploma or GED
Healthcare referral management
Freight shipment tracking
Task prioritization
Organizational skills
Healthcare provider information
Patient transport coordination
Computer skills
Health information management
Order tracking

Full Job Description

VGM HOMELINK Patient Care Coordinators [PCCs] work every day to ensure patients across the country receive the highest standard of care. PCCs do this by performing high quality customer service in an office environment utilizing various forms of technology. A PCC will verify insurance coverage and coordinate healthcare services such as durable medical equipment, medical supplies, transportation services, and home care services.

Click below to view a day in the life of a Patient Care Coordinator and learn how you can make a difference every day.

The first few months as a PCC will be spent in training learning business objectives, software systems, and job specific goals. The HOMELINK training team will provide in depth training on of insurance carrier contracts, medical coding, and specific service coordination.

Commitment to in-depth knowledge of our insurance carrier contracts and expectations, as well as high-quality standards and timeliness are crucial to success in this role. This VGM job is fast-paced and ever changing; individuals with high energy and passion for exceeding expectations are encouraged to apply. This VGM job functions in a call-center environment and at minimum 75% of this role will included communication via phone with in-coming and out-going calls.

Working Location: Our main VGM campus is in Waterloo, Iowa - this position is flexible in on-site, hybrid or remote.

Hours: Monday-Friday; Full-time (40 hours/week) opportunities available with periodic on call responsibilities.

1st shift, 8am-5pm CST
2nd shift, 10am-7pm CST
Responsibilities/Duties of the Job

Manage a large volume of phone and email communication, including incoming and outgoing calls. Respond to customer queries accurately and in a timely manner through email or phone.
Answer calls from referral sources in a timely and professionally manner, and secure referral orders by telephone, fax, and electronic means – being on the phone is a required and essential function of the job
Contact payer sources to verify or obtain eligibility, benefits, and/or authorization for items or services requested
Coordinate the delivery of medical equipment and other healthcare services, including contacting the patient, provider, or on-line tracking system to confirm items were delivered and/or services rendered
Obtain and send appropriate clinical documentation to payer sources by fax or electronic means to assist them in determining the medical necessity of medical equipment and other healthcare services
Communicate with supervisor, other PCC’s, and external parties to keep them informed of order status, including outlying situations that could affect the referral
Collect and enter accurate and detailed patient, provider, and payer information into the Company’s claims platform on a real-time basis to prevent delays in billing or services
Answer questions from patients, providers, Company staff, and payer sources
Ensure patients receive a high standard of service delivery and care through a series of follow-up quality questions to ensure Company quality standards are being met
Identify and resolve service issues and complaints
Intake of new orders as needed during busy times, even if not the primary job responsibility of the PCC
Maintain knowledge of Company policy and procedures and regulatory, contractual, and accreditation requirements
Reviews orders to ensure they are setup with accurate coding, quantity, and pricing
Maintain availability for after hours on-call coverage
Follow strict confidentiality and HIPAA privacy and security guidelines
Perform other duties as assigned
Key responsibilities do not include conducting utilization management activities that require clinical judgement or interpretation of clinical information, including issuing denials of service authorization requests

Position Qualifications

Education/Experience:

High school diploma/GED desired
Equivalent professional experience preferred
Must comply with continuing education per Company, regulatory, contractual, and accreditation requirements’

Skills and competencies:

Customer service focused
High degree of integrity and trust
Ability to multitask and prioritize
Possesses strong time management and organization skills
Detailed oriented
Works well under pressure and is punctual
Flexible with the ability to routinely adapt to change
Team player with excellent communication skills
Knowledge of various healthcare industry billing and/or coding terminologies such as ICD-10, HCPCS, CPT, modifiers, and various Medicare NCD’s and LCD’s

Physical Requirements:

Working at a physical desk, moving about the office and facility as needed for work
Operation of office machinery and equipment
Visual abilities to include reading, distance vision, and peripheral vision

This job description reflects the general duties of the job but is not a detailed description of all duties which may be inherent to the position. Reasonably related additional duties may be assigned to the individual Associate.

VGM Group, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, pregnancy, national origin, disability, genetic information, military or veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Apply Now

Refine Your Search

utilization management jobs in waverly, ia

Patient Care Coordinator

EMT, Paramedic or LPN (PRN)

Pediatric/NICU RN Unit Manager

Patient Care Tech - Med/Surg .6 FTE 3rd shift

Program Director

Nursing Informaticist & Quality Specialist 1.0 FTE 1st shift

Registered Nurse

Board-Certified General Medicine Provider

RN Care Coordinator Acute Care

Registered Nurse, Emergency Department, PRN

Labor & Delivery RN .75 FTE Weekend Package, Days

Hospitalist Nurse- Palliative Care

Labor & Delivery RN 0.3 FTE, 7p-7a

Labor and Delivery Registered Nurse, .6 FTE, 1st shift

Market Chief Medical Officer - Waterloo

Registered Nurse, Labor & Delivery .75FTE Weekend Package, 3rd shift

Rehab Director

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)

Complex Care Manager RN-Western MA (Hybrid)

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