Case Manager RN
About The Position
Use Your Clinical Expertise Beyond the Bedside Are you an experienced RN who enjoys critical thinking, collaboration, and advocating for patients? Join MercyOne's Care Coordination team and play a vital role in ensuring patients receive the right care at the right time while helping navigate complex healthcare journeys. As an RN Case Manager, you'll partner with physicians, care teams, insurers, and community resources to support patients across the continuum of care. From reviewing admission status and coordinating services to assisting with discharge planning and connecting patients to vital resources, you'll make a meaningful impact on both patient outcomes and the healthcare experience.
Requirements
- Current Iowa RN license required
- Minimum 5 years of clinical nursing experience required
- Mandatory Reporter Abuse Training required within 3 months of hire
Nice To Haves
- BSN or healthcare-related degree preferred
- Utilization Review certification preferred within 12 months of hire
- Knowledge of CMS regulations, insurance eligibility, and utilization review processes preferred
Responsibilities
- Coordinate resources and services to support patients throughout their healthcare journey.
- Collaborate with physicians, social workers, therapists, wound care specialists, and other interdisciplinary team members.
- Assist with discharge planning, transitions of care, and community resource connections.
- Help patients access primary care providers, medical services, and support programs that promote positive health outcomes.
- Perform admission, concurrent, and post-discharge utilization reviews.
- Apply Milliman Care Guidelines and payer-specific criteria to determine appropriate patient status.
- Work directly with physicians to clarify admission status and facilitate second-level physician reviews when needed.
- Obtain insurance authorizations and continued stay approvals while advocating for appropriate patient care.
- Collaborate with Case Management, Revenue Cycle, Verification, Admitting, and Medical Eligibility teams.
- Communicate status changes, insurance updates, and authorization needs promptly.
- Participate in denial management, appeals processes, and peer-to-peer reviews.
- Ensure accurate documentation within the medical record and STAR system.
Benefits
- stability of a weekday schedule
- collaborative, supportive work environment
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
