WestDesMoinesRecruiter Since 2001
the smart solution for West Des Moines jobs

Clinical Care Reviewer - Utilization Management

Company: ZolonTech
Location: Ames
Posted on: June 24, 2019

Job Description:

Schedule - Contract to Perm Contract - 3 Months JOB-RELATED EXPERIENCE AND SKILLS Registered Nurse graduated from an accredited program . Current unrestricted Iowa Registered Nurse license or LPN Valid Driver's License and reliable automobile transportation for on-site assignments and off-site work related activities.. THE PRIMARY PURPOSE OF THE JOB IS TO: Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the nurse's discretion to pend requests for additional information and/or request clarification. The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed. The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application. COMPETENCIES Excellent oral and written communication skills. Ability to identify problems and recommend solutions. Self-directed/Ability to work independently. Excellent decision making skills. Excellent time management skills, prioritizing work and meeting timelines. Ability to advocate for member/member family needs. Dedicated to meeting the expectations and requirements of internal and external customers. Obtains continuing education required to maintain professional licensure. Ability to achieve required performance results on all audits and Inter Rater Reliability (Peer to Peer). PHYSICAL EFFORT/WORKING CONDITIONS Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. Primarily works in a climate controlled office based setting. May require driving or commuting to health care facilities. Some positions may require a large amount of walking within the health care facility.

Keywords: ZolonTech, West Des Moines , Clinical Care Reviewer - Utilization Management, Executive , Ames, Iowa

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Business Liaison Consultant 3 / Supplier Management
Description: Job DescriptionAt Wells Fargo, we want to satisfy our customers financial needs and help them succeed financially. Were looking for talented people who will put our customers at the center of everything (more...)
Company: Wells Fargo
Location: West Des Moines
Posted on: 07/23/2019

Enterprise Applications Manager - Waterloo
Description: Hawkeye Community College is hiring An Enterprise Applications Manager will join this growing team in Waterloo, IA.--As an Enterprise Application Manager, you will have the chance to lend your expertise (more...)
Company: Hawkeye Community College
Location: Waterloo
Posted on: 07/24/2019

Warehouse Manager
Description: Job Description br br Now hiring a Warehouse Manager for a direct hire opportunity br br Warehouse Manager Job Responsibilities: br br Provides materials, equipment, and supplies by directing (more...)
Company: Kelly Services
Location: Des Moines
Posted on: 07/24/2019


92Y Unit Supply Specialist - Warehouse Manager
Description: 92Y Unit Supply Specialist - Warehouse Manager br br Job ID: 1077751 br br Job Views: 14 br br Location: WATERLOO, Iowa, United States br br ZIP Code: 50703 br br Job Category: Supply (more...)
Company: Army National Guard
Location: Waterloo
Posted on: 07/23/2019

General Manager
Description: Description br br TrinityRail Maintenance Services is searching for a talented team player to fill the open position of General Manager at our Shell Rock, IA facility We welcome your ideas and your (more...)
Company: Trinity Industries
Location: Waterloo
Posted on: 07/23/2019

RN Clinic Nurse, Pain Management
Description: Position: Clinic Nurse Department: Pain Management Status: FT Shift/Hours:
Company: Broadlawns Medical Center
Location: Des Moines
Posted on: 07/24/2019

Project Manager
Description: Our client is looking for a Project Manager to lead a minimum of one-year project, delivering system functionality and enhancements to modernize the client s services system, and sunset related legacy (more...)
Company: IO Datasphere
Location: Des Moines
Posted on: 07/23/2019

Associate Director, FPA
Description: Save Education - Bachelor's Degree Skills - Hyperion - 401 k - Accounting - Microsoft Office - Leadership Experience Benefits - Tuition Reimbursement - Dental Insurance - Health Insurance - Vision Insurance (more...)
Company: Collins Aerospace
Location: West Des Moines
Posted on: 07/23/2019

Development Director, Gala
Description: Overview Are you ready to join an organization where you can make an extraordinary impact every day Imagine all Americans enjoying ideal cardiovascular health free of heart disease and stroke. At the (more...)
Company: American Heart Association
Location: West Des Moines
Posted on: 07/23/2019

Project Manager
Description: Description- TeamTechnologies The team consists of a QA lead, system admin, vendor PM, multiple business SMEs Technology consists of MS Project, Visio, JIRA, Google suite Daily duties include Managing (more...)
Company: Solomons International
Location: Des Moines
Posted on: 07/24/2019

Log In or Create An Account

Get the latest Iowa jobs by following @recnetIA on Twitter!

West Des Moines RSS job feeds