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Insurance Utilization Reviewer Jobs in Iowa (NOW HIRING)

Virginia Gay Hospital

Utilization Tech

Vinton, IA

Utilization Tech/Nurse M-F 1st shift, 32 biweekly hours 8-4:30 Clinical background preferred About ... review. Compensation amp; Benefits * Competitive salary * Health, dental, vision, life insurance ...

Trinity Health

Utilization Review RN

Des Moines, IA · On-site

Interacts with insurance providers to obtain authorization and continued stay approval for ... Conducts admission review per the Utilization Management Plan to ensure that the hospitalization is ...

Actalent

Utilization Management Nurse

Des Moines, IA · On-site

$40/hr

Conduct post-service reviews for medical necessity and experimental/investigational services ... Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term ...

HealthCheck360

Utilization Management Assistant

Dubuque, IA · On-site

$39K - $45K/yr

... insurance verification, LPN, CNA, Medical Assistants, or individuals with a background in customer ... The Utilization Management Assistant answers first level calls in Utilization Review for ...

HealthCheck360

Utilization Management CNA

Asbury, IA · On-site

... insurance verification, LPN, CNA, Medical Assistants, or individuals with a background in customer ... The Utilization Management Assistant answers first level calls in Utilization Review for ...

HealthCheck360

Utilization Management CNA

Dubuque, IA · On-site

... insurance verification, LPN, CNA, Medical Assistants, or individuals with a background in customer ... The Utilization Management Assistant answers first level calls in Utilization Review for ...

HealthCheck360

Utilization Management CNA

Dubuque, IA · On-site

... insurance verification, LPN, CNA, Medical Assistants, or individuals with a background in customer ... The Utilization Management Assistant answers first level calls in Utilization Review for ...

Access Dubuque

Utilization Management CNA

Dubuque, IA · On-site

... insurance verification, LPN, CNA, Medical Assistants, or individuals with a background in customer ... They will evaluate certification requests by reviewing the group specific requirements and will ...

Access Dubuque

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 ...

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Insurance Utilization Reviewer information

What is an insurance utilization reviewer?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.

What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are popular job titles related to Insurance Utilization Reviewer jobs in Iowa?

For Insurance Utilization Reviewer jobs in Iowa, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Reviewer jobs in Iowa look for?

The top searched job categories for Insurance Utilization Reviewer jobs in Iowa are:

Insurance Utilization Reviewer jobs near you

Utilization Tech

Virginia Gay Hospital

Vinton, IA

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Job description

Utilization Tech/Nurse
M-F 1st shift, 32 biweekly hours
8-4:30
Clinical background preferred
About VGH
Virginia Gay Hospital, established in Vinton in 1923, is an independent, nonprofit critical access hospital supported by a strong local community. The organization includes a 25-bed hospital and four family medical clinics located throughout Benton County, Iowa, offering high-quality, local healthcare and opportunities for professional growth and meaningful patient relationships.
Position Summary
  • ESSENTIAL DUTIES AND RESPONSIBILITIES
•The Utilization Review Tech/Nurse is responsible for the utilization review for preadmission screenings of patients, monitoring of patient status/needs, and notification of third-party payors, precertification of outpatient procedures, medication preauthorization and auditing charts as requested. The UR Tech/Nurse is responsible for the InterQual review of charts to assist with determination of appropriate level and length of stay.
MINIMUM QUALIFICATIONS (from job description)
•Current Iowa nursing license, preferred. Graduated from a state approved nursing program if applicable. Maintains current BCLS if indicated. Would prefer candidate to have previous education and experience as an MA/RN/LPN, Utilization Review Nurse and/or have experience in physician office preauthorization and utilization review.
Compensation amp; Benefits
  • Competitive salary
  • Health, dental, vision, life insurance, supplemental insurance
  • Retirement plan with match
  • Paid time off
  • License and Continuing Education Reimbursement available.
Equal Opportunity Statement
Virginia Gay Hospital is an equal opportunity employer.

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