Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Case Manager RN
Des Moines, IA · On-site
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Case Manager RN
Des Moines, IA · On-site
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
ED RN Case Manager Nights
Des Moines, IA · On-site
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
ED RN Case Manager Nights
Des Moines, IA · On-site
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
ED RN Case Manager Nights
Des Moines, IA · On-site
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
ED RN Case Manager Nights
Des Moines, IA · On-site
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements. * Apply Milliman Care Guidelines and payer ...
Regional Reimbursement Nurse Consultant
West Des Moines, IA · Remote
$90K - $110K/yr
Review PDPM classifications, clinical documentation, diagnosis coding, and reimbursement accuracy * Support Case Mix Index improvement through accurate assessment and documentation * Audit MDS ...
Quick apply
Regional Reimbursement Nurse Consultant
West Des Moines, IA · Remote
$90K - $110K/yr
Review PDPM classifications, clinical documentation, diagnosis coding, and reimbursement accuracy * Support Case Mix Index improvement through accurate assessment and documentation * Audit MDS ...
Support Utilization Management & Clinical Review * Perform admission, concurrent, and post-discharge utilization reviews. * Apply Milliman Care Guidelines and payer-specific criteria to determine ...
Support Utilization Management & Clinical Review * Perform admission, concurrent, and post-discharge utilization reviews. * Apply Milliman Care Guidelines and payer-specific criteria to determine ...
Utilization Review 1099 information
What is a utilization review 1099?
A Utilization Review 1099 position refers to a healthcare professional, often a nurse or therapist, who works as an independent contractor (not a direct employee) to review medical cases for necessity and efficiency. The '1099' designation means they receive a Form 1099 for tax purposes and are responsible for their own taxes. Utilization Review specialists evaluate patient records to ensure treatments are appropriate and meet insurance or regulatory guidelines. These roles are often remote and offer flexible hours, but do not provide traditional employee benefits.
What are the key skills and qualifications needed to thrive as a utilization review 1099?
To thrive as a Utilization Review 1099 professional, you need a strong clinical background (often as a registered nurse or similar), experience with medical necessity criteria, and familiarity with insurance guidelines. Proficiency with utilization management software, electronic health records (EHRs), and knowledge of regulatory requirements are typically required, along with URAC or CCM certification being advantageous. Excellent analytical thinking, attention to detail, and effective communication skills are essential for collaborating with healthcare providers and payers. These skills ensure accurate, efficient review of patient care for coverage decisions, compliance, and cost-effective healthcare delivery.
What are some typical challenges faced by utilization review 1099 contractors, and how can they be managed?
Utilization Review professionals working as 1099 contractors often face challenges such as fluctuating caseloads, varying client requirements, and the need to stay current with changing regulations independently. Unlike full-time employees, contractors must also manage their own schedules, billing, and sometimes provide their own resources and training. To succeed, it's important to establish clear communication with clients, maintain up-to-date credentials, and leverage professional networks or continuing education resources to stay informed about industry changes.
What is the difference between Utilization Review 1099 vs Utilization Review Nurse?
| Aspect | Utilization Review 1099 | Utilization Review Nurse |
|---|---|---|
| Credentials | Varies; often self-employed or independent contractors | Registered Nurse (RN) license required |
| Work Environment | Remote or freelance; contract basis | Healthcare facilities, insurance companies, or clinics |
| Employer/Industry Usage | Freelance or independent consulting in healthcare | Hospitals, insurance providers, healthcare organizations |
| Work Focus | Reviewing medical necessity for insurance claims | Assessing patient records, making clinical decisions |
Utilization Review 1099 typically refers to independent contractors reviewing insurance claims, often working remotely. Utilization Review Nurse is a licensed RN performing clinical assessments within healthcare settings. While both roles involve utilization review, the 1099 role emphasizes independent contracting, whereas the nurse role requires clinical credentials and direct patient or clinical record involvement.
What are popular job titles related to Utilization Review 1099 jobs in Iowa?
For Utilization Review 1099 jobs in Iowa, the most frequently searched job titles are:
- Per Diem Utilization Review Nurse
- Home Based Utilization Review Nurse
- Part Time Utilization Review Nurse
- Remote Utilization Review Rn
- Clinical Review Nurse Remote
- No Experience Utilization Review Nurse
- Flex Schedule Remote Utilization Review Nurse
- Overnight Utilization Review Nurse
- Full Time Remote Utilization Review Nurse
- Utilization Review Physician
What job categories do people searching Utilization Review 1099 jobs in Iowa look for?
The top searched job categories for Utilization Review 1099 jobs in Iowa are:
- Seasonal Remote Utilization Review
- Remote Anthem Utilization Review Nurse
- Optum Utilization Review Nurse
- Retrospective Review Nurse
- Remote Utilization Review
- Work From Home Utilization Review
- Utilization Review
- Nurse Practitioner Utilization Review
- Remote Bcba Utilization Review
- Anthem Utilization Review Nurse
What cities in Iowa are hiring for Utilization Review 1099 jobs?
Cities in Iowa with the most Utilization Review 1099 job openings:
Trinity Health rating
6.6
Based on 354 frontline employees who took The Breakroom Quiz
572nd of 898 rated healthcare providers
Job description
Employment Type:Full timeShift:Description:RN Case Manager (Onsite)
Shift:
Monday-Friday (8 hours) No Weekends
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