Top 10 Utilization review nurse Jobs in Clive, Ia

Medical Review Nurse (AIMRR) 2
EPATHUSA INC —Clive, IA
- $76,875 - $97,375 a year
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science in Nursing
13d
Utilization Management Nurse
Cottingham & Butler —Des Moines, IA
- Full-time
- Bilingual
- Mid-level
- Profit sharing
- Health savings account
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Senior Review Coordinator (Oncology) - Utilization Management (RN)
Telligen —West Des Moines, IA
- Email
- Hybrid work
- Nursing
- RN License
- Research
Quick Apply
RN Case Manager
Cottingham & Butler —Des Moines, IA
- Full-time
- Nursing
- RN License
- Mid-level
- Profit sharing
- Health savings account
Quick Apply
Travel Case Management RN
Fastaff —United States
- Up to $2,826 a week
- Full-time
- Background check
- Nursing
- RN License
- Mileage reimbursement
- Health savings account
Quick Apply
7d
Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- LVN
- RN License
- Mid-level
- Travel reimbursement
- Health savings account
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Medical Review Nurse (AIMRR) 2
EPATHUSA INC —Clive, IA
Registered Nurse, with a current unobstructed license to practice nursing in the United States. A Bachelor’s Degree in Nursing (BSN) or other related field is…
$76,875 - $97,375 a year
13d
Senior Review Coordinator (Oncology) - Utilization Management (RN)
Telligen —West Des Moines, IA
Current RN license that is recognized in the relevant jurisdiction(s)or other certification directly relevant to the type of review performed; Ability to obtain…
Quick Apply

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
RN Case Manager
Sheakley —Columbus, OH
A current, unrestricted Ohio state licensure or certification in a health or human services discipline that allows the professional to conduct an assessment…
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utilization review nurse jobs near clive, ia

Medical Review Nurse (AIMRR) 2

EPATHUSA INC -
Clive, IA

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Job Details

Full-time
$76,875 - $97,375 a year
13 days ago

Qualifications

Utilization review
RN License

Full Job Description

Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews (Standard or Program Integrity) to make coverage determinations based on applicable Medicare coverage policies and payment rules, coding guidelines, National and Local Coverage Determinations, utilization/practice guidelines, clinical review judgment and when appropriate, monitor for potential indicators of fraud, waste, and abuse. Provides professional assessment, planning, coordination, implementation, and reporting of complex data to support the Medical Review Accuracy Contract (MRAC).

Essential Functions

Perform complex medical record and claims review in accordance with all State and Federal mandated regulations/guidelines.
Accurately enter medical review data into the medical review system.
Apply clinical review judgment, based on clinical experience when applicable and review completeness of documentation to determine if documentation supports claim as billed.
Reasonably determines appropriateness to consult a Subject Matter Expert (SME) for clarification.
When performing Program Integrity (PI) reviews, assess investigative allegations and medical review findings, and/or other claims data to determine patterns and detect potential indicators of fraud, waste and abuse (FWA).
Accurately identify additional findings in the review of evidence of potential FWA not detected by the Medical Review Contractor.
Consistently meet or exceed productivity and accuracy standards of 98% minimum IRR established by the customer and/or the Company.

Registered Nurse, with a current unobstructed license to practice nursing in the United States. Graduate of a Board approved Registered Nursing program.
A Bachelor’s Degree in Nursing (BSN) or other related field is preferred.
Certification in coding highly preferred.
A minimum of five (5) years clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic-based medical practice.
A minimum of three (3) or more years’ experience in medical/utilization medical record review particularly with Medicare and/or Medicaid.
Minimum of 2 (two) years’ experience in the medical review processes of MACs, SMRC, CERT, QICs and/or BFCC-QIOs.
Desired experience performing medical review for fraud, waste, and abuse (FWA) investigations.
Knowledgeable of ICD-9-CM, ICD-10, CPT-4 and HCPCS coding.
One year or more of utilizing InterQual and/or Milliman guidelines against inpatient services experience is preferred.

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utilization review nurse jobs in clive, ia

Medical Review Nurse (AIMRR) 2

Utilization Management Nurse

Senior Review Coordinator (Oncology) - Utilization Management (RN)

RN Case Manager

Travel Case Management RN

Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license

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