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Pediatric Utilization Management Jobs in Iowa (NOW HIRING)

Imh

Pediatric Physical Therapist

Saint George, UT · On-site

$43.09 - $66.47/hr

Manages all aspects of patient care and education, including supervising assistants, aides, office ... Participates in utilization review audits. * Meetings : Participates in patient care conferences ...

CHI Health Mercy Council Bluffs

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 - ...

CommonSpirit Health

Charge RN

Council Bluffs, IA

... Management * Assists with budget goals, payroll monitoring, and responsible resource utilization ... Pediatric Advanced Life Support, within 5 - months and * Neonatal Resuscitation Program, within 6 - ...

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Pediatric Utilization Management information

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 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 the difference between Pediatric Utilization Management vs Pediatric Case Management?

AspectPediatric Utilization ManagementPediatric Case Management
CredentialsRN, licensed healthcare professionals, certifications in utilization reviewRN, social worker, case management certification
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, community health settings
Employer & Industry UsageInsurance providers, managed care organizationsHospitals, outpatient clinics, social services
FocusReviewing medical necessity, approving services, optimizing resource useCoordinating 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 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:

Pediatric Utilization Management jobs near you
Infographic showing various Pediatric Utilization Management job openings in Iowa as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Nurse Manager-Case Management

Trinity Health

Mason City, IA • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 7 days ago

Trinity Health rating

6.6

Company rating: 6.6 out of 10

Based on 354 frontline employees who took The Breakroom Quiz

572nd of 898 rated healthcare providers

Job description

Employment Type:
Full timeShift:
Day Shift
Description:
Position Purpose:
The Case Management Manager provides both strategic and operational leadership for acute care case management services, including utilization management, social work, care transitions, and complex care coordination. This role collaborates closely with senior leadership, physicians, and interdisciplinary teams to drive performance, improve patient outcomes, and ensure efficient, compliant care delivery. The manager leverages data to optimize key metrics such as length of stay, readmissions, and denials. Additionally, the role leads and develops supervisory staff while advancing standardized workflows and a culture of continuous improvement.
What you will Do:
  • Lead ministry level acute care management strategy and execute across utilization management, case management, social work, care transitions, and complex care coordination, aligning regional priorities with local operational needs.
  • Partner with senior leadership, including the CMO, CNO, physicians, and interdisciplinary teams, to drive performance improvement and lead change management efforts that support adoption of new workflows, tools, and care delivery initiatives.
  • Ensure staffing models, workflows, and escalation processes support efficient patient flow and discharge while maintaining consistent adherence to standard work, organizational policies, and regulatory requirements.
  • Provide formal coaching and mentorship, while leading and developing care management staff and coordinators.
  • Promote engagement, accountability, and leadership development, supporting succession planning and leadership readiness across the acute care management team.
  • Collaborate with physicians, nursing leadership, and cross-functional partners (quality, finance, revenue cycle, compliance) to support safe, compliant, high-quality care, while representing acute care management in market-level operational, clinical, and performance improvement initiatives.
  • Drive performance across key metrics including length of stay, avoidable days, denials, level of care accuracy, readmissions, and documentation integrity by leveraging data and dashboards to identify trends, prioritize improvements, sustain outcomes, and escalate unresolved risks or systemic barriers.

Hours/Schedule:
8-hour shifts
40 hours weekly
Day shift
Minimum Qualifications:
  • Must possess a comprehensive knowledge of nursing as normally obtained through bachelor's degree in Nursing, and three to five (3-5) years of progressive acute care management or related healthcare leadership experience.
  • Master's Degree in nursing, health care administration, or related healthcare field preferred.
  • Current Iowa RN license, (MercyOne Genesis, excluding Aledo and DeWitt, - current Registered Nurse (RN) license in either Iowa or Illinois is required at the time of hire. A secondary RN license for the other state must be obtained within 12 months of the hire date.)
  • Professional Care Management Certification (ACMA, CCM, CMAC) preferred.
  • Proof of completion of Mandatory Reporter - Child and/or Dependent Adult
  • Abuse training within three (3) months of hire.
  • Colleagues employed and working solely in facilities located in Illinois are exempt from this requirement in accordance with applicable state requirements.
  • Demonstrated depth of knowledge in utilization management, care coordination, throughput optimization, and regulatory compliance.

Position Highlights and Benefits:
  • Education Assistance offered
  • Effective Day 1 Benefit Package (Medical, Dental, Vision, and more) for positions 16 hours per week or greater
  • Competitive wages; including weekend and night differentials
  • Generous paid time off program
  • Retirement Savings program with employer match starting on Day 1

Ministry/Facility Information:
MercyOne North Iowa Medical Center provides expert health care to 15 counties.
MercyOne North Iowa Medical Center is a 342 bed, regional referral teaching hospital in Mason City, Iowa. MercyOne New Hampton Medical Center is an 11 bed, rural access hospital in New Hampton, Iowa. Our service area spans 15 counties across northern Iowa and southern Minnesota. We serve a population over 260,000.
With more than 3,000 colleagues and a medical staff of almost 500 physicians and allied health professionals, MercyOne North Iowa Medical Center is the largest employer in the region.
MercyOne Medical Group - North Iowa is part of Iowa's largest multispecialty clinic systems. In north Iowa, our clinics are made up of more than 25 primary care, pediatric, internal medicine and specialty clinics.
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

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