Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
ED RN Case Manager Nights
Des Moines, IA · On-site
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
ED RN Case Manager Nights
Des Moines, IA · On-site
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
ED RN Case Manager Nights
Des Moines, IA · On-site
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
ED RN Case Manager Nights
Des Moines, IA · On-site
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Director of Case Management (RN) - Hospital | $93K-$126K + Relocation
Ottumwa, IA · On-site
$93K - $125K/yr
Participate in Utilization Review and Revenue Cycle committees * Support discharge planning and ... Life Insurance * Retirement plan * Paid Time Off (PTO)
Quick apply
Director of Case Management (RN) - Hospital | $93K-$126K + Relocation
Ottumwa, IA · On-site
$93K - $125K/yr
Participate in Utilization Review and Revenue Cycle committees * Support discharge planning and ... Life Insurance * Retirement plan * Paid Time Off (PTO)
ED RN Case Manager Nights
Des Moines, IA · On-site
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
ED RN Case Manager Nights
Des Moines, IA · On-site
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Case Manager RN
Des Moines, IA · On-site
Utilization Review certification preferred within 12 months of hire * Knowledge of CMS regulations, insurance eligibility, and utilization review processes preferred * Mandatory Reporter Abuse ...
Case Manager RN
Des Moines, IA · On-site
Utilization Review certification preferred within 12 months of hire * Knowledge of CMS regulations, insurance eligibility, and utilization review processes preferred * Mandatory Reporter Abuse ...
Case Manager RN
Des Moines, IA · On-site
Utilization Review certification preferred within 12 months of hire * Knowledge of CMS regulations, insurance eligibility, and utilization review processes preferred * Mandatory Reporter Abuse ...
Case Manager RN
Des Moines, IA · On-site
Utilization Review certification preferred within 12 months of hire * Knowledge of CMS regulations, insurance eligibility, and utilization review processes preferred * Mandatory Reporter Abuse ...
Case Manager RN
Des Moines, IA · On-site
Utilization Review certification preferred within 12 months of hire * Knowledge of CMS regulations, insurance eligibility, and utilization review processes preferred * Mandatory Reporter Abuse ...
Case Manager RN
Des Moines, IA · On-site
Utilization Review certification preferred within 12 months of hire * Knowledge of CMS regulations, insurance eligibility, and utilization review processes preferred * Mandatory Reporter Abuse ...
Comfort with electronic health records (EHRs) and utilization review software * Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity ...
Comfort with electronic health records (EHRs) and utilization review software * Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity ...
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...
Internal Medicine Physician General Internist - Physicians Only Apply - Perm
Des Moines, IA · On-site
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...
Internal Medicine Physician General Internist - Physicians Only Apply - Perm
Des Moines, IA · On-site
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...
Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm
Des Moines, IA · On-site
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...
Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm
Des Moines, IA · On-site
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...
UR Coordinator
Clive, IA · On-site
... insurance offering, a physician network and various related services located all over the U.S ... review organizations or comparable entities. Licensure: R.N is required - with BSN highly preferred.
UR Coordinator
Clive, IA · On-site
... insurance offering, a physician network and various related services located all over the U.S ... review organizations or comparable entities. Licensure: R.N is required - with BSN highly preferred.
Insurance Utilization Review information
See Iowa salary details
$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
How much do insurance utilization review jobs pay per hour?
As of Sep 9, 2026, the average hourly pay for insurance utilization review in Iowa is $39.71, according to ZipRecruiter salary data. Most workers in this role earn between $31.39 and $45.62 per hour, depending on experience, location, and employer.
What is an insurance utilization review?
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.
What are the key skills and qualifications needed to thrive in insurance utilization review?
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.
What are the most common challenges faced by insurance utilization review professionals?
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.
How do I get into an insurance utilization review?
To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.
Is insurance utilization review a stressful job?
Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.
What are the most commonly searched types of Insurance Utilization Review jobs in Iowa?
The most popular types of Insurance Utilization Review jobs in Iowa are:
What are popular job titles related to Insurance Utilization Review jobs in Iowa?
For Insurance Utilization Review jobs in Iowa, the most frequently searched job titles are:
- Flex Schedule Remote Utilization Review Nurse
- Therapist Utilization Review Remote
- Utilization Review Physician
- Evening Optum Health Utilization Review
- Behavioral Health Utilization Review
- Home Based Utilization Review Nurse
- Remote Utilization Review Rn
- Full Time Remote Utilization Review Nurse
- Freelance Utilization Review Nurse
- Part Time Utilization Review Nurse
What job categories do people searching Insurance Utilization Review jobs in Iowa look for?
The top searched job categories for Insurance Utilization Review jobs in Iowa are:
- Lpn Utilization Review
- Utilization Review Salary
- Weekday Insurance Utilization Review
- Remote Aetna Utilization Review
- Utilization Review Case Manager
- Commission Authorization Utilization Review Bcba
- Seasonal Remote Utilization Review
- Per Diem Remote Occupational Therapy Utilization Review
- Behavioral Utilization Review
- Dental Utilization Review
Case Manager RN Weekend Days
Des Moines, IA • On-site
Trinity Health •
Health Care and Social Assistance • 10K+ employees10,000+ employees
Part-time
Re-posted 13 days ago
Trinity Health rating
6.6
Based on 354 frontline employees who took The Breakroom Quiz
576th of 898 rated healthcare providers
Job description
Employment Type:Part timeShift:Weekend ShiftDescription:RN Case Manager (Onsite)
Shift:
Weekends: Saturday and Sunday 7AM - 7:30 PM
General Summary:
Responsible for the review of inpatient and outpatient admission records for appropriate admission status at Mercy Medical Center and Mercy West Lakes. Works in collaboration with the attending physician and the Case Management staff utilizing admission criteria guidelines-and second level physician review process when appropriate. Interacts with insurance providers to obtain authorization and continued stay approval for admission. Collaborates with the Verification department, Revenue cycle and Medical Eligibility to facilitate the establishment of the correct payer source for patient stay and the documentation of the interactions in the STAR admitting system
Key ResponsibilitiesPerform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements.
Apply Milliman Care Guidelines and payer-specific criteria to determine appropriate patient status.
Collaborate with attending physicians to clarify admission status and initiate second-level physician reviews as needed.
Communicate status changes promptly to Case Management, Admitting, and other relevant departments.
Provide patient/family education and issue Notices of Status Change when required.
Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system.
Submit timely clinical information to payers to prevent technical denials and support authorization and continued stay.
Review and route denial notifications for appeal consideration; collaborate with post-denials, RAC, and appeal teams.
Monitor insurance coverage and communicate updates to verification and financial teams.
Participate in peer-to-peer reviews and advocate for appropriate admission status and continued stay.
Current Iowa RN license.
Minimum of five (5) years of clinical nursing experience.
BSN or healthcare-related degree preferred.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care.
Strong clinical judgment, communication, and independent decision-making skills.
Utilization Review certification within 12 months of hire preferred.
Completion of Mandatory Reporter abuse training within three (3) months of hire.
Primarily office-based with computer, phone, and documentation tasks.
Light physical activity with occasional lifting; use of assistive devices and additional personnel as required.
Visual acuity sufficient to review medical records and electronic systems.
Ability to work collaboratively in a fast-paced, high-stress healthcare environment while maintaining professionalism and courtesy.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
What Trinity Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Trinity Health
Sourced by ZipRecruiter
Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Livonia, MI, US