RN Utilization Review & Medical Appeals Specialist
Molina Healthcare of Illinois
Molina Healthcare in Des Moines seeks a qualified Registered Nurse (RN) for clinical review responsibilities that ensure medical necessity for claims and appeals processing. The ideal candidate will have a minimum of 2 years clinical experience and proficiency in ICD-10 and CPT coding. This position emphasizes strong analytic, communication, and problem-solving skills. Molina offers a competitive compensation package within a supportive environment focused on quality care. #J-18808-Ljbffr Molina Healthcare
$29.05 - $67.97 per hour
...Description Job Summary Utilizing clinical knowledge... ..., responsible for review of documentation to ensure medical necessity and... ...review of appeals for denied prior authorizations... ...Registered Nurse (RN). License must be... ...Medical Audit Specialist (CMAS), Certified Case...SuggestedHourly payWork experience placementWork at office$29.05 - $67.97 per hour
Job Summary Utilizing clinical knowledge and experience... ..., responsible for review of documentation to ensure medical necessity and... ...concurrent review of appeals for denied prior... ...Registered Nurse (RN). License must be active... ...Medical Audit Specialist (CMAS), Certified Case...SuggestedHourly payWork experience placementWork at office- ...based in Des Moines is seeking a Clinical Care Reviewer for a 3-month position. The role requires evaluating clinical information for medical necessity and benefit guidelines,... ...care. Candidates must have an active Iowa RN license or LPN, along with experience in clinical...Suggested
- ...Telligen is seeking a qualified individual for a role in medical management based in West Des Moines, Iowa. The selected candidate will conduct utilization reviews and provide technical assistance while training other team members. Experience in clinical or behavioral...Suggested
- IMCS Group is seeking an experienced nurse for a 10-month contract role primarily focused on reviewing clinical data and managing member appeal requests in accordance with company policies. The position allows for remote work, preferably from Iowa, with possible on-site...SuggestedRemote jobContract work
- ...Medical Billing Specialist I (Full-Time) Admin & Support (Operations, Accounting, HR, HIM, Marketing... ...codes, and diagnosis codes, utilizing appropriate modifiers and diagnosis... ...basis within specified timelines. Review and appeal unpaid claims to resolve payment discrepancies...Full time
- ...Medical Billing And Coding Specialist QuickVisit Urgent Care is seeking a Medical Billing and Coding Specialist... ...claims to send to insurance. Review and correct invalid claims from clearing... ...to resolve and avoid denials and appeals. Collaborates with team members to...Temporary workLocal areaRemote workMonday to FridayShift work
$23 - $28 per hour
...Description Job Description Medical Billing Specialist Location: Ankeny, IA... ...Key Responsibilities Review, research, and resolve high... ...discrepancies and submit appeals as needed. Post payments... ...organizational backlog efficiently. Utilize Excel daily, including...Hourly payContract workCasual workLocal areaImmediate startMonday to Friday$71.1k - $97.8k
...our caring community The Utilization Management Registered Nurse uses... ...and communication of medical services and benefit administration... ...processing time frames. (i.e. 10 reviews per day?) You will... ...hold Compact Registered Nurse (RN) license in your state of residence...Bi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workHome office- ...Prepare, organize, and efficiently utilize supplies and equipment to... ...care under the supervision of RN. Staff Related * Assists in training... ...accurate and timely manner. * Review treatment sheets for... ...CPR certification. Fresenius Medical Care maintains a drug-free workplace...Immediate start
$18 - $20 per hour
...Overview The ROI Specialist is responsible for providing support at a specified client... ...Information (ROI) requests for patient medical record requests* Responsibilities # Determines records to be released by reviewing requestor information in accordance with...Work experience placementWork at office$231.5k - $396.86k
...Medical Director Associate - CarelonRx Location: This role enables associates... ...pharmacy prior authorization reviews to ensure turnaround time is met and... ...of the United States when conducting utilization review or an appeals consideration and cannot be located...Full timeTemporary workWork experience placementLocal areaWeekend work1 day per week- ...Clinical Care Reviewer RN 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...
- ...Fri 8am-5pm CST - No OT Responsibilities Review clinical data to determine claim payment... ...the denials and submitting cases to the Medical Director for review Prepare case review for... ...information received Generate appropriate appeal resolution communication to the member...Contract workRemote workShift work
$65.9k - $107.9k
Sr Supplier Medical Process Specialist Zurich North America is seeking a skilled and motivated Nurse to... ...Conduct regular quality audits and/or reviews to ensure accuracy and completeness of... ...: Licensed Registered Nurse (RN) in the state of residence Bachelors...Full timeTemporary workWork at officeLocal areaRemote workVisa sponsorship- ...ED Patient Case Manager RN (Onsite) Shift/Hours... ...Responsible for the review of inpatient and outpatient... ...status at Mercy Medical Center and Mercy West Lakes... ...Case Management staff utilizing admission criteria guidelines... ...notifications for appeal consideration; collaborate...Full timeWork at officeLocal areaFlexible hoursShift workNight shiftDay shift
- ...Clinical Care Reviewer UM (RN/LPN) Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-... ...Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. ~ Using clinical knowledge and...Work at office
- Integrated Resources, Inc. is seeking a Clinical Care Reviewer to perform medical necessity reviews as directed by the unit Supervisor. The role involves using clinical knowledge to evaluate service requests and ensure compliance with medical management guidelines. This...
- A leading staffing firm is seeking a Clinical Care Reviewer to conduct thorough medical necessity reviews under the supervision of a unit supervisor. The role requires a Registered Nurse with at least 3 years of experience in a clinical setting, focusing on ensuring that...
- A leading staffing firm is seeking a Clinical Care Reviewer UM for a three-month position with potential for extension. The role involves conducting medical necessity reviews and requires a Registered Nurse license along with excellent communication and problem-solving...
- ...but are not limited to, chart reviews, patient safety audits, shift... ...unit and nursing resource utilization based on established admission... ...documentation in the electronic medical record. Leads or... ...nursing preferred. ~12 months of RN experience required. 24 months...Full timeLocal areaShift workNight shift
$2,401 per week
...Prime Staffing is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing... ...Unit Salary information and unbiased reviews from leading Travel Nurse Agencies... ...our clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing...Permanent employmentTemporary workShift work$38 per hour
...Responsibilities: Utilizes the nursing process to plan,... ...or supervisor Administers medications and treatments as prescribed,... ...effectiveness of intervention Reviews plan of care and program protocols... ...Current Registered Nurse (RN) License for the state in which...Hourly payWeekly payContract workTemporary workReliefShift workWeekend work- ...Offering a Limited-Time $20,000 RN Sign-On Bonus! UnityPoint... ...Dialysis team at Iowa Methodist Medical Center provides specialized renal... ...and psycho-social assessment. Utilizes physical assessment data,... ...identified goals and expectations reviewed each shift to verify...Daily paidFull timeTemporary workRelocationRelocation packageShift workWeekend workAfternoon shift
$10k
...care for patients with acute medical and surgical conditions. Through evidence-based practice, utilizes critical thinking to assess, plan... ...-based care. The Acute Care RN manages a diverse patient population... ...(s) to interventions. Review/modifies/revises the outcome-...Part timeWork at officeLocal areaRelocation packageShift workNight shift- ...Prepares, organizes, and efficiently utilizes supplies and equipment to prevent waste.... ...application accurately and in a timely manner. Reviews health care record for completeness and... ...90 days of employment Fresenius Medical Care maintains a drug-free workplace in...Immediate startFlexible hours
$38 per hour
...RN Homecare Maxim Healthcare in Des Moines, IA is hiring... ...Responsibilities: Utilizes the nursing process to plan,... ...or supervisor Administers medications and treatments as prescribed,... ...effectiveness of intervention Reviews plan of care and program protocols...Weekly payFull timeContract workTemporary workPart timeReliefShift workNight shift- ...Offering a Limited-Time $20,000 RN Sign-On Bonus! UnityPoint... ...Dialysis team at Iowa Methodist Medical Center provides specialized renal... ...and psycho-social assessment. Utilizes physical assessment data,... ...identified goals and expectations reviewed each shift to verify...Daily paidFull timeTemporary workRelocationRelocation packageShift workWeekend workAfternoon shift
- ...supplies in the department, change out linen, cleans transport carts.• Utilizes a holistic approach (considering physical, psych/social,... ...linen.• Assists in patient care under the direct supervision of the RN• Performs tasks as delegated by team members. Qualifications...Daily paidTemporary workMonday to FridayShift work
- ...and specimens including transport of patients with traction. Assists in maintaining a clean, orderly and safe environment. Utilizes a holistic approach (considering physical, psych/social, spiritual, educational, safety, and related criteria) appropriate to the...Daily paidTemporary workMonday to FridayShift workDay shift
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