Are you a dedicated, compassionate health care professional with the ability to adapt to changes, anticipate needs, and pay excellent attention to detail? Do you thrive in a collaborative setting, while exhibiting independent and critical thinking where resourcefulness is key? Are you motivated and inspired by the opportunity to utilize your clinical expertise in a fast-paced production environment? If you said yes, consider applying today!
Our Utilization Management Nurse will provide service and support to members and health care providers, including pre-service reviews, out of network referrals and support for Wellmark’s Health Plan of Iowa. This individual will utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, medical criteria (InterQual), and benefit information, and provide consultation and responses to utilization management requests. Additionally, this individual may complete clinical reviews and apply utilization review criteria for patient admissions and various levels of care, continued stay reviews, and/or discharge planning.
This position is located in our Des Moines, IA office.