RN - Case Manager

Indiana University Health•Indianapolis, IN

62d•Onsite

About The Position

IU Health University Hospital is dedicated to delivering high-quality patient care through effective care coordination and seamless transitions across care settings. We are seeking a passionate and experienced RN to join our team as a Case Manager, responsible for planning and coordinating patient care from admission through post-discharge. The RN-Case Manager plays a vital role in ensuring smooth patient transitions across various care environments. This position involves assessing patient needs, coordinating multidisciplinary care, and communicating with patients, families, providers, and payers to optimize outcomes and resource utilization. The nurse collaborates closely with the care team to develop individualized discharge plans, manage insurance coverage, and administer education and prevention programs.

Requirements

Associate's Degree in Nursing required.
New ASN RNs hired after January 1, 2013, will be required to complete their BSN within 5 years of hire date.
Active RN license in Indiana or Nurse Licensure Compact (NLC).
3-5 years of clinical experience in acute care required.
Familiarity with Medicare/Medicaid, insurance policies, and regulatory requirements is advantageous.
Ability to understand third-party contractual arrangements and the denial/appeal process is a plus.
Proficiency with Windows, Cerner, SMS, and other relevant software applications.
Strong clinical background with excellent assessment and communication skills.
Knowledge of InterQual Acute Level of Care Criteria and federal coverage guidelines preferred.

Nice To Haves

Case Management certification preferred.
Familiarity with Medicare/Medicaid, insurance policies, and regulatory requirements is advantageous.
Ability to understand third-party contractual arrangements and the denial/appeal process is a plus.
Knowledge of InterQual Acute Level of Care Criteria and federal coverage guidelines preferred.

Responsibilities

Plan and coordinate patient care from admission through post-discharge, ensuring appropriate levels of care and services.
Perform accurate and timely discharge planning, including documentation and communication.
Collaborate with the multidisciplinary team to develop comprehensive, individualized care plans.
Work with third-party payers to verify coverage, obtain authorizations, and support appeals.
Educate patients and families on post-discharge care, safety, and prevention strategies.
Assist with third-party denials, appeals, and understanding contractual arrangements.
Ensure compliance with Medicare, Medicaid, insurance, and regulatory guidelines.
Utilize various software applications including Windows, Cerner, and SMS for documentation and communication.