Des Moines, IA · Remote
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Des Moines, IA · Remote
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
Cedar Rapids, IA · On-site
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
Cedar Rapids, IA · On-site
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
Cedar Rapids, IA · On-site
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
Cedar Rapids, IA · On-site
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
Cedar Rapids, IA · On-site
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
Cedar Rapids, IA · On-site
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
$1K - $2K/wk
Responsible for case coordination of patients and insurance precertification/utilization review. Patients served include adult and geriatric. St. Luke's C.A.R.E. delivery model (Continuity ...
Assess post-discharge needs and coordinate appropriate referrals, services, and insurance authorizations * Perform utilization management and level-of-care reviews to support medical necessity and ...
Assess post-discharge needs and coordinate appropriate referrals, services, and insurance authorizations * Perform utilization management and level-of-care reviews to support medical necessity and ...
$20.09 - $24.16
2% of jobs
$24.16 - $28.22
9% of jobs
$31 is the 25th percentile. Wages below this are outliers.
$28.22 - $32.29
21% of jobs
The median wage is $35.58 / hr.
$32.29 - $36.35
23% of jobs
$36.35 - $40.42
13% of jobs
$43.58 is the 75th percentile. Wages above this are outliers.
$40.42 - $44.48
10% of jobs
$44.48 - $48.54
8% of jobs
$48.54 - $52.61
5% of jobs
$52.61 - $56.67
5% of jobs
$56.67 - $60.74
2% of jobs
$60.74 - $64.80
2% of jobs
$20
$39
$64
One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.
To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.
An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.
$21 - $26.50/hr
Other
Medical, Dental, Vision, Life, Retirement, PTO
Posted 9 days ago
Bilingual RN Case Manager
Location: Remote.
We are seeking a compassionate and detail-oriented Bilingual RN Case Manager to join our team. This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment.
Key Responsibilities:
Qualifications:
Full-Time Benefits - Most benefits start day 1
About HealthCheck360
HealthCheck 360 was created with the employer's needs and the participant's experience in mind. We focus on reducing medical costs, while increasing employee engagement and productivity. This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and supporting positive behavior change through our Health Coaching and Condition Management programs.
Sourced by ZipRecruiter
Fitness and sports centers
201 - 500 Employees
Dubuque, IA, US
2007
