Provides medical leadership of all for utilization management, cost containment, and medical ... Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Previous ...
Provides medical leadership of all for utilization management, cost containment, and medical ... Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Previous ...
Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm
Des Moines, IA · On-site
Provides medical leadership of all for utilization management, cost containment, and medical ... Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Previous ...
Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm
Des Moines, IA · On-site
Provides medical leadership of all for utilization management, cost containment, and medical ... Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Previous ...
Provides medical leadership of all for utilization management, cost containment, and medical ... Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Previous ...
Provides medical leadership of all for utilization management, cost containment, and medical ... Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Previous ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
Staff Nurse - Pediatric Cath Lab
Iowa City, IA · On-site
$61K/yr
Medical
Dental
Life
Retirement
PTO
... Nurse Manager. Position Specific Responsibilities * Incorporate the scientific, behavioral and ... Participate in research utilization activities and integrate findings into practice. * Apply ...
Staff Nurse - Pediatric Cath Lab
Iowa City, IA · On-site
$61K/yr
Medical
Dental
Life
Retirement
PTO
... Nurse Manager. Position Specific Responsibilities * Incorporate the scientific, behavioral and ... Participate in research utilization activities and integrate findings into practice. * Apply ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
... to manage care and length of stay, improve resource utilization and decrease costs to patients and the institution while providing personalized care on 24/7 basis. This position is located in Iowa ...
Jumpstart Registered Nurse
Dubuque, IA · On-site
$2.0K/mo
Medical * NICU * Operating Room * PACU * Pediatrics * Rehab * Surgical Services Qualifications ... MercyOne Utilization Management Nurse Cottingham & Butler/ SISCO Nurse Manager Medical Unit ...
Jumpstart Registered Nurse
Dubuque, IA · On-site
$2.0K/mo
Medical * NICU * Operating Room * PACU * Pediatrics * Rehab * Surgical Services Qualifications ... MercyOne Utilization Management Nurse Cottingham & Butler/ SISCO Nurse Manager Medical Unit ...
Pediatric/NICU RN Unit Manager
Waterloo, IA · On-site
... management. * Monitors staffing pattern that supports effective clinical services within ... Adjusts utilization of staff and materials to actual workload. * Makes decisions about and ...
Pediatric/NICU RN Unit Manager
Waterloo, IA · On-site
... management. * Monitors staffing pattern that supports effective clinical services within ... Adjusts utilization of staff and materials to actual workload. * Makes decisions about and ...
Charge RN
$36.94 - $53.56/hr
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Charge RN
$36.94 - $53.56/hr
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Outcomes Manager, Acute Rehabilitation, Per Diem, Camden
$38.33 - $59.58/hr
Medical
Dental
Vision
Life
Retirement
PTO
... pediatrics. Location: Lourdes Health System - 1600 Haddon Ave Remote Type: On-Site Employment Type ... Minimum 3 years clinical nursing (RN) experience or Social Work Minimum of 1 year Case Management ...
Outcomes Manager, Acute Rehabilitation, Per Diem, Camden
$38.33 - $59.58/hr
Medical
Dental
Vision
Life
Retirement
PTO
... pediatrics. Location: Lourdes Health System - 1600 Haddon Ave Remote Type: On-Site Employment Type ... Minimum 3 years clinical nursing (RN) experience or Social Work Minimum of 1 year Case Management ...
Charge RN
Council Bluffs, IA · On-site
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Charge RN
Council Bluffs, IA · On-site
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Charge RN
Council Bluffs, IA · On-site
$36.94 - $53.56/hr
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Charge RN
Council Bluffs, IA · On-site
$36.94 - $53.56/hr
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Charge RN
$36.94 - $53.56/hr
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Charge RN
$36.94 - $53.56/hr
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
... pediatric trauma victims in the state's only designated Level I Trauma Center and certified ... Manage department office space- identify, review, and implement space utilization plans and oversee ...
... pediatric trauma victims in the state's only designated Level I Trauma Center and certified ... Manage department office space- identify, review, and implement space utilization plans and oversee ...
Charge RN
Council Bluffs, IA · On-site
$36.94 - $53.56/hr
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Charge RN
Council Bluffs, IA · On-site
$36.94 - $53.56/hr
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Charge RN
Council Bluffs, IA · On-site
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Charge RN
Council Bluffs, IA · On-site
... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...
Pediatric Utilization Management information
What is the difference between Pediatric Utilization Management vs Pediatric Case Management?
| Aspect | Pediatric Utilization Management | Pediatric Case Management |
|---|---|---|
| Credentials | RN, licensed healthcare professionals, certifications in utilization review | RN, social worker, case management certification |
| Work Environment | Insurance companies, healthcare organizations, utilization review departments | Hospitals, clinics, community health settings |
| Employer & Industry Usage | Insurance providers, managed care organizations | Hospitals, outpatient clinics, social services |
| Focus | Reviewing medical necessity, approving services, optimizing resource use | Coordinating care, supporting patient needs, discharge planning |
While both roles involve working with pediatric patients, Pediatric Utilization Management primarily focuses on reviewing and approving healthcare services for medical necessity within insurance or managed care settings. Pediatric Case Management emphasizes coordinating ongoing patient care and support services across healthcare providers and community resources.
What are some common challenges faced by professionals in pediatric utilization management, and how can they be addressed?
Professionals in Pediatric Utilization Management often encounter challenges such as balancing cost-effective care with the unique needs of pediatric patients, staying updated with evolving clinical guidelines, and communicating effectively with both providers and families. Navigating insurance requirements while advocating for appropriate treatments requires strong clinical knowledge and negotiation skills. Building collaborative relationships with multidisciplinary teams and ongoing professional development can help address these challenges and ensure the best outcomes for young patients.
What are the key skills and qualifications needed to thrive as a pediatric utilization management nurse, and why are they important?
To thrive in Pediatric Utilization Management, you need a solid background in pediatric nursing, critical thinking, and knowledge of healthcare regulations, generally supported by an RN license and experience in pediatrics. Familiarity with utilization review software, electronic medical records (EMRs), and certification such as Certified Case Manager (CCM) or Utilization Review Accreditation Commission (URAC) is often required. Excellent communication, attention to detail, and strong organizational skills are crucial for collaborating with medical teams and advocating for appropriate patient care. These competencies ensure effective care coordination, regulatory compliance, and optimal outcomes for pediatric patients.
What is pediatric utilization management?
Pediatric Utilization Management (UM) is a healthcare process that reviews and evaluates the medical necessity, efficiency, and appropriateness of healthcare services provided to children. Professionals in this field assess treatment plans, hospital stays, procedures, and medications to ensure they align with evidence-based guidelines and are truly needed for a pediatric patient's care. The goal is to optimize health outcomes for children while managing healthcare costs and resources efficiently. Pediatric UM often involves collaboration between healthcare providers, insurance companies, and families to make informed decisions about a child's medical care.
What are popular job titles related to Pediatric Utilization Management jobs in Iowa?
For Pediatric Utilization Management jobs in Iowa, the most frequently searched job titles are:
What job categories do people searching Pediatric Utilization Management jobs in Iowa look for?
The top searched job categories for Pediatric Utilization Management jobs in Iowa are:
What cities in Iowa are hiring for Pediatric Utilization Management jobs?
Cities in Iowa with the most Pediatric Utilization Management job openings:
Full-time
Re-posted 7 days ago
Job description
Medical Doctors Only Apply. A Administrative Physician practice is seeking a qualified physician for Des Moines, IA. This and other physician jobs brought to you by ExactMD.
Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers.
Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies.
Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees
Consults on MCO clinical policy related to Substance Use Disorders and the cases of individual members for the MCM program on a routine basis.
Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred.
Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred.