Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
ED RN Case Manager Nights
Des Moines, IA · On-site
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
ED RN Case Manager Nights
Des Moines, IA · On-site
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care. * Strong clinical judgment, communication, and independent decision-making skills.
Comfort with electronic health records (EHRs) and utilization review software * Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity ...
Comfort with electronic health records (EHRs) and utilization review software * Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity ...
Participate in Utilization Review and Revenue Cycle committees * Support discharge planning and ... Life Insurance * Retirement plan * Paid Time Off (PTO)
Quick apply
Participate in Utilization Review and Revenue Cycle committees * Support discharge planning and ... Life Insurance * Retirement plan * Paid Time Off (PTO)
Utilization Management Nurse
Asbury, IA · On-site
Review requests and match up to an evidence-based guideline to ensure proper care and ensure the ... Company-paid Term Life/Accidental Death Insurance
Utilization Management Nurse
Asbury, IA · On-site
Review requests and match up to an evidence-based guideline to ensure proper care and ensure the ... Company-paid Term Life/Accidental Death Insurance
Comfort with electronic health records (EHRs) and utilization review software * Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity ...
New
Comfort with electronic health records (EHRs) and utilization review software * Familiarity with state and federal guidelines, HIPAA compliance, and insurance or Medicaid-specific medical necessity ...
New
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 ...
Utilization Management Nurse
Dubuque, IA · On-site
Review requests and match up to an evidence-based guideline to ensure proper care and ensure the ... Company-paid Term Life/Accidental Death Insurance About Cottingham & Butler: At Cottingham & Butler ...
Utilization Management Nurse
Dubuque, IA · On-site
Review requests and match up to an evidence-based guideline to ensure proper care and ensure the ... Company-paid Term Life/Accidental Death Insurance About Cottingham & Butler: At Cottingham & Butler ...
Internal Medicine Physician General Internist - Physicians Only Apply - Perm
Des Moines, IA · On-site
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 ...
Internal Medicine Physician General Internist - Physicians Only Apply - Perm
Des Moines, IA · On-site
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 ...
Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm
Des Moines, IA · On-site
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 ...
Family Practice Physician Traditional Practitioner - Physicians Only Apply - Perm
Des Moines, IA · On-site
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
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 ...
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:
Trinity Health rating
6.6
Based on 354 frontline employees who took The Breakroom Quiz
569th of 891 rated healthcare providers
Job description
Employment Type:
Part timeShift:
Weekend Shift
Description:
RN Case Manager (Onsite)
Shift:
Weekends: Saturday and Sunday 7AM - 7:30 PM
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 Responsibilities
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.
Part timeShift:
Weekend Shift
Description:
RN Case Manager (Onsite)
Shift:
Weekends: Saturday and Sunday 7AM - 7:30 PM
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 Responsibilities
- Perform 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
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About Trinity Health
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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