Case Manager-RN

Trinity Health•Mason City, IA

1d•Onsite

About The Position

The Utilization Review (UR) Case Manager – Post-Acute Prior Authorization role performs Utilization Review activities and serves as the central coordinator for post-acute prior authorizations (PAs) for skilled nursing, swing bed, CAH swing, acute rehab, LTACH, and other post-acute 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 follow-up, denial-prevention support, external notifications, data extraction from the chart, Epic work queue tasks, supporting second IMM processes as needed, coordination with payers and post-acute facilities, and assists with other appropriate administrative support for the acute care management team.

Requirements

Registered Nurse (RN) with an active, unrestricted license
Minimum five years of direct RN practice.
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.
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.

Nice To Haves

Bachelor of Science in Nursing (BSN) strongly preferred
Prior experience interacting with insurance companies, payers, or care partners—or a strong interest in learning how to navigate authorization processes and advocate for timely, appropriate patient discharges—is preferred.

Responsibilities

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 maintain standardized PA workflows for consistency and efficiency.
Communicates PA status and clinical needs to post-acute facilities, payers, case managers, social workers, and fellow 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.
Extracts meaningful data from the medical record to support UR RN clinical reviews.
Identifies potential concurrent denials and routes information to UR RNs promptly.