AnkenyRecruiter
the smart solution for Ankeny jobs

Clinical Care Reviewer - Utilization Management

Company: ZolonTech
Location: Ankeny
Posted on: January 30, 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, Ankeny , Clinical Care Reviewer - Utilization Management, Executive , Ankeny, 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


Des Moines OfficeTeam Staffing Manager
Description: JOB REQUISITIONDes Moines OfficeTeam Staffing ManagerLOCATIONIA DES MOINESJOB DESCRIPTIONJob SummaryAs a Staffing Manager you will be responsible for: ul li Business development: Develop and grow (more...)
Company: Robert Half International
Location: Des Moines
Posted on: 02/21/2019

Wealth Financial Advisor- Wealth Management Group
Description: At Bank of the West, our people are having a positive impact on the world. We're investing where we feel we can make the most impact, like advancing diversity and women entrepreneurship programs, financing (more...)
Company: Bank of the West
Location: West Des Moines
Posted on: 02/19/2019

Senior EHS Manager
Description: Senior EHS Manager br Ames, IA br 90-130K 15 bonus br xA0 br Seeking a Senior Environmental/Health/Safety Manager EHS for our Ames, IA facility This EHS Manager will develop, implement, (more...)
Company: Job Juncture
Location: Ames
Posted on: 02/21/2019


Account Manager- UC/ Telecommunications
Description: Requisition ID br br 2018-2302 br br OVERVIEW br br Black Box Network Services, the global leader in communication system integration, is looking for a Sr. Account Executive with a proven (more...)
Company: Black Box Network Services
Location: Des Moines
Posted on: 02/21/2019

Automotive Tool Field Sales / Territory Manager
Description: Build a Great Career and a Great Life. Feel the freedom independence of managing your own protected route selling our National brands.-- Join our team today as an Automotive Tool Sales / Route with (more...)
Company: Mac Tools
Location: Des Moines
Posted on: 02/22/2019

Current College Students - In-Store Management Executive Internship (Nebraska)
Description: One of the world's leading and most recognized brands comes to life in our stores, where guests are still captivated by everything that made them fall in love with Target. Our approximately 1800 locations (more...)
Company: Target
Location: Waterloo
Posted on: 02/19/2019

VP of Information Technology Shared
Description: JOB DUTIES: br br Provide IT Leadership for Company and its US BUs. Provide IT leadership and strategic input on all IT issues affecting the organization: Serve as a valued advisor to leaders of Company (more...)
Company: Health & Wellness, Ankeny, IA
Location: Ankeny
Posted on: 02/21/2019

RN Case Manager, Hospice Home Care
Description: Overview The Home Hospice Registered Nurse plans, organizes and directs home hospice care services, initiates, and implements care primarily in the patient's home environment. The Home Hospice RN fulfills (more...)
Company: UnityPoint Health
Location: Waterloo
Posted on: 02/19/2019

Senior Vice President-Commercial Lender
Description: Would you enjoy Commercial Lending where local decisions are made to meet the needs of the customer and as a lender, you are invited to be a part of that decision-making
Company: Freedom Financial Bank
Location: Des Moines
Posted on: 02/21/2019

Office Manager II
Description: Office Manager II Imagine if hellip You could lead people within an organization that still values giving back and offers flexible schedules You could make an impact in a measurable way, and that impact (more...)
Company: H&R BLOCK
Location: Ames
Posted on: 02/21/2019

Log In or Create An Account

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

Ankeny RSS job feeds