Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Des Moines, IA · On-site
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Des Moines, IA · On-site
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Quick apply
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Des Moines, IA · On-site
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Des Moines, IA · On-site
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Quick apply
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Dubuque, IA · On-site
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Des Moines, IA · Remote
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Des Moines, IA · Remote
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Des Moines, IA · Remote
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Quick apply
Bilingual RN Case Manager
Des Moines, IA · Remote
$21 - $26.50/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Asbury, IA · On-site
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-time benefits - most benefits start day 1: * Medical, Dental, Vision Insurance * Flex Spending ...
Bilingual RN Case Manager
Asbury, IA · On-site
$20.25 - $25.75/hr
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-time benefits - most benefits start day 1: * Medical, Dental, Vision Insurance * Flex Spending ...
... utilization review, and care teams Establish and maintain peer-to-peer review protocols with insurance providers Opportunity to influence quality, compliance, and operational performance across the ...
... utilization review, and care teams Establish and maintain peer-to-peer review protocols with insurance providers Opportunity to influence quality, compliance, and operational performance across the ...
Facilitate effective communication among physicians, case management, utilization review, and care teams* Establish and maintain peer-to-peer review protocols with insurance providers* Opportunity to ...
Facilitate effective communication among physicians, case management, utilization review, and care teams* Establish and maintain peer-to-peer review protocols with insurance providers* Opportunity to ...
RN Case Manager
Des Moines, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Des Moines, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Asbury, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Asbury, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
RN Case Manager
Dubuque, IA · On-site
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Provide telephonic case management and utilization review for assigned consumers. * Develop ... Full-Time Benefits - Most benefits start day 1 * Medical, Dental, Vision Insurance * Flex Spending ...
Weekday Insurance Utilization Review information
What is the difference between Weekday Insurance Utilization Review vs Weekday Claims Processor?
| Aspect | Weekday Insurance Utilization Review | Weekday Claims Processor |
|---|---|---|
| Primary Role | Assessing medical necessity and appropriateness of services | Processing and reviewing insurance claims for payment |
| Credentials | Often requires healthcare or insurance certifications | Typically requires insurance or administrative experience |
| Work Environment | Healthcare settings, insurance companies | Insurance companies, healthcare offices |
| Focus | Medical review and authorization | Claims data entry and verification |
Weekday Insurance Utilization Review focuses on evaluating medical necessity, while Weekday Claims Processors handle the administrative processing of insurance claims. Both roles are essential in the insurance industry but serve different functions related to claims management and healthcare authorization.
What cities in Iowa are hiring for Weekday Insurance Utilization Review jobs? Cities in Iowa with the most Weekday Insurance Utilization Review job openings:
Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm
Des Moines, IA
Full-time
Posted 6 days ago
Job description
Medical Doctors Only Apply. A Family Practice Physician Traditional Practitioner 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.