Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
New
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
New
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.
Case Manager RN Weekends
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 Weekends
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.
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 ...
New
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 ...
New
Participate in Utilization Review and Revenue Cycle committees * Support discharge planning and ... Life Insurance * Retirement plan * Paid Time Off (PTO)
Quick apply
Participate in Utilization Review and Revenue Cycle committees * Support discharge planning and ... Life Insurance * Retirement plan * Paid Time Off (PTO)
Utilization Review certification preferred within 12 months of hire * Knowledge of CMS regulations, insurance eligibility, and utilization review processes preferred * Mandatory Reporter Abuse ...
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 ...
Review requests and match up to an evidence-based guideline to ensure proper care and ensure the ... Company-paid Term Life/Accidental Death Insurance
Review requests and match up to an evidence-based guideline to ensure proper care and ensure the ... Company-paid Term Life/Accidental Death Insurance
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 ...
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 ...
Utilization Management Nurse
Dubuque, IA · On-site
Review requests and match up to an evidence-based guideline to ensure proper care and ensure the ... Company-paid Term Life/Accidental Death Insurance About Cottingham & Butler: At Cottingham & Butler ...
Utilization Management Nurse
Dubuque, IA · On-site
Review requests and match up to an evidence-based guideline to ensure proper care and ensure the ... Company-paid Term Life/Accidental Death Insurance About Cottingham & Butler: At Cottingham & Butler ...
RN Case Manager
Asbury, IA · On-site
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 ...
RN Case Manager
Asbury, IA · On-site
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 ...
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 ...
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/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 ...
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/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 ...
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 ...
Quick apply
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 ...
Bilingual RN Case Manager
Des Moines, IA · On-site
$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 ...
Bilingual RN Case Manager
Des Moines, IA · On-site
$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 ...
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/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 ...
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/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 ...
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 Aug 16, 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 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.
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 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 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:
- Therapist Utilization Review Remote
- Evening Utilization Review Nurse
- Evening Optum Health Utilization Review
- Flex Schedule Remote Utilization Review Nurse
- Utilization Review Physician
- Behavioral Health Utilization Review
- Per Diem Utilization Review Nurse
- Full Time Remote Utilization Review Nurse
- Part Time Utilization Review Nurse
- Utilization Management
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:
- Utilization Review Salary
- Remote Optum Utilization Review
- Remote Aetna Utilization Review
- Commission Authorization Utilization Review Bcba
- Seasonal Remote Utilization Review
- Remote Dental Utilization Review
- Utilization Review Case Manager
- Optum Utilization Review Nurse
- Authorization Utilization Review Bcba
- Utilization Review 1099
Trinity Health rating
6.6
Based on 354 frontline employees who took The Breakroom Quiz
569th of 887 rated healthcare providers
Job description
Employment Type:Full 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
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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