Case Manager RN

Trinity Health • Mason City, IA

21d • Onsite

About The Position

The Utilization Review Case Manager responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services. Assists the organization in ensuring compliance with CMS rules and regulations and conditions of participation as well as commercial payer specific guidelines to prevent denials and revenue loss. Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines.

Requirements

• Licensed registered nurse in the state of Iowa
• Bachelor's Degree required
• Five years of experience as a registered nurse involving community contact, knowledge of managed care, resource utilization criteria, Medicaid, insurance coverage for acute care and skilled care
• Knowledge/skills with data systems, continuous quality improvement (CQI), community healthcare resources
• Ability to work independently in analyzing data, exercising judgment to arrive at conclusions
• Ability to establish and maintain working relationships
• Assertiveness and critical thinking
• Ability to communicate effectively and tactfully both verbally and in writing
• Skill in exercising a high degree of initiative, judgment, discretion, and decision-making
• Ability to plan, prioritize, organize and direct the work of others
• Ability to communicate clearly and effectively
• Willingness to accept responsibility and to be accountable for own actions

Nice To Haves

• BSN preferred
• Utilization management focused certifications that are recognized in the state of Iowa preferred
• Case management experience preferred

Responsibilities

• Case screening
• Insurance approval
• Assurance of timely services
• Facilitation of discharge with transition to the appropriate services
• Ensuring compliance with CMS rules and regulations and conditions of participation
• Ensuring compliance with commercial payer specific guidelines to prevent denials and revenue loss
• Effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines to achieve patient outcomes.

Benefits

• Competitive wages
• Weekend and night differentials
• Benefit Package (Blue Cross Blue Shield of Michigan) for positions 16 hours per week or greater
• Educational assistance
• Success Sharing - a bonus when the organization meets its goals

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level