Utilization Review Manager Jobs in Iowa (NOW HIRING)

Utilization Review (UR) Assistant

Full time

Day Shift

Full Time

Day Shift

40 hours weekly

The Utilization Review (UR) Assistant supports utilization management activities and serves as the central coordinator for postacute prior authorizations (PAs) for skilled nursing, swing bed, CAH swing, acute rehab, LTACH, and other postacute levels of care. This role drives timely authorization determinations, reduces authorization-related delays, supports throughput goals, decreases avoidable inpatient days, and helps ensure efficient discharge planning. Responsibilities include PA submission and followup, denial-prevention support, external notifications, data extraction from the chart, Epic work queue tasks, supporting second IMM processes as needed, coordination with payers and postacute facilities, and administrative support for the acute population care management team.

1) Post-Acute Prior Authorization Management (Primary Function)

• Centralizes, submits, monitors, and follows up on post-acute prior authorizations using payer portals, phone calls, and clinical documentation workflows.
• Ensures complete and accurate clinical packets; escalates delays when authorization timelines exceed expectations.
• Documents all PA activity in Epic and maintains standardized PA workflows for consistency and efficiency.
• Communicates PA status and clinical needs to postacute facilities, payers, case managers, social workers, and UR RNs.
• Provides external notification of discharges and post-acute transfers.
• Supports implementation and evaluation of the centralized PA workflow, including establishing a regular cadence for outcome monitoring.

2) Utilization Management & Denial Prevention Support

• Extracts meaningful data from the medical record to support UR/Concurrent Review RN clinical reviews.
• Identifies potential concurrent denials and routes information to UR RNs promptly.
• Gathers documentation for denial reviews and assists with payer communication.
• Inputs payer authorization information into systems to support payment of services rendered.
• Reviews and monitors UR reports to identify necessary actions to reduce denials.

3) Throughput Collaboration

• Acts as a liaison between internal departments, physicians, outside facilities, and hospital units to promote patient flow, discharge coordination, and receipt of medically appropriate care at the correct level.

4) Patient & Payer Communications

• Meets with admitted patients to review Medicare notices (such as the Important Message from Medicare/IMM).
• Clarifies payer medical benefits, policies, and procedures to patients, physicians, office staff, contract providers, and facilities.

Education & Licensure

• Must be one of the following:
  • Licensed Practical Nurse (LPN) with an active, unrestricted license, OR
  • Certified Medical Assistant (CMA/CCMA/RMA) with active, current certification.
• Minimum of two (2) years of practice in the licensed/certified discipline (LPN or CMA) required.

Experience

• Minimum two years of direct LPN or CMA practice required.
• Demonstrated experience in UR, discharge planning, or postacute workflows preferred.

Certifications

• Basic Life Support (BLS) within 60 days of hire; must maintain certification.
• Mandatory Reporter – Child & Dependent Adult Abuse within 6 months of hire; renewal per policy.

Knowledge, Skills & Abilities

• Strong organizational and time-management skills; detail-oriented.
• Proficient in email, internet navigation, payer portals, and Microsoft Excel and Word.
• Ability to multitask and work independently while collaborating with multidisciplinary teams.
• Strong customer-service skills aligned with MercyOne mission and values.

Corporate & Compliance Expectations

• Upholds the Mission, Values, Standards of Conduct, and all organizational policies/procedures.
• HIPAA Security Level: High — access to restricted/confidential PHI; compliance with all security policies is required.

• 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

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.