Top 26 Utilization review Jobs in Dallas Center, 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
PT Access Specialist - Full Time - 7:30A-4P
Broadlawns Medical Center —Des Moines, IA
- Full-time
- Hospital
- Mid-level
- 1 year
- Free parking
- Health insurance
Quick Apply
13h
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
RN Quality Coordinator - Hybrid
MercyOne —Des Moines, IA
- Full-time
- Nursing
- RN License
- 5 years
Case Manager RN
MercyOne —Des Moines, IA
- Full-time
- Nursing
- RN License
- 5 years
ER Case Manager RN Weekends
MercyOne —Des Moines, IA
- Weekends as needed
- Nursing
- RN License
- Hospital
3d
Case Management Nurse - Oncology or Transplant Experience
Innovative Care Management, Inc. —Des Moines, IA
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
Vice President, Dental Director
Delta Dental of Iowa —Johnston, IA
- Full-time
- Up to 50% travel
- High school
- 5 years
- Dental insurance
- Vision insurance
ED RN Case Manager Nights
MercyOne —Des Moines, IA
- 12 hour shift
- Nursing
- RN License
- 5 years
Rehab Director
Blue Stone Therapy —Des Moines, IA
- $25 - $50 an hour
- Full-time
- Skilled nursing facility
- Physical & Rehabilitation Medicine
- Mid-level
- Health savings account
- Paid holidays
Quick Apply
Clinical Director
LifeSkills Connection Inc —Ankeny, IA
- Online Application
- LMFT
- Doctoral degree
- HIPAA
- Health savings account
- Paid holidays
Quick Apply

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Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
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UR Coordinator, Full Time
RiverVista Behavioral Hospital —Columbus, OH
High school diploma required; associate or bachelor’s degree in nursing, healthcare administration, or related field preferred. Must be 21 or older.
$24 - $32 an hour
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utilization review jobs near dallas center, ia

Medical Review Nurse (AIMRR) 2

EPATHUSA INC -
Clive, IA

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Job Details

Full-time
$76,875 - $97,375 a year

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 jobs in dallas center, ia

Medical Review Nurse (AIMRR) 2

PT Access Specialist - Full Time - 7:30A-4P

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

RN Case Manager

RN Quality Coordinator - Hybrid

Case Manager RN

ER Case Manager RN Weekends

Case Management Nurse - Oncology or Transplant Experience

Vice President, Dental Director

ED RN Case Manager Nights

Rehab Director

Clinical Director

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