RN Utilization & Care Review Specialist

Fabergent; Des Moines (IA); On-site; USD 70,000 - 85,000; Full time

Job summary

A healthcare management company based in Des Moines is seeking a Clinical Care Reviewer for a 3-month position. The role requires evaluating clinical information for medical necessity and benefit guidelines, documenting case information, and ensuring continuity of care. Candidates must have an active Iowa RN license or LPN, along with experience in clinical settings and quality assurance. This position offers competitive pay and a collaborative work environment.

Qualifications

• 3 to 5 years of experience in a related clinical setting.
• Two years of experience in managed care quality assurance or utilization review.

Responsibilities

• Conduct timely reviews of all requests for services to meet medical necessity criteria.
• Evaluate clinical information against plan review criteria and benefit guidelines.
• Document pertinent case information and dispositions for approvals and denials.

Skills

Clinical experience

Active Iowa RN license or LPN

UM Experience / Waiver Knowledge

Education

Associates RN degree

Bachelor’s degree preferred

Job description

A healthcare management company based in Des Moines is seeking a Clinical Care Reviewer for a 3-month position. The role requires evaluating clinical information for medical necessity and benefit guidelines, documenting case information, and ensuring continuity of care. Candidates must have an active Iowa RN license or LPN, along with experience in clinical settings and quality assurance. This position offers competitive pay and a collaborative work environment.