RN Case Manager - Primary Care

Indiana University Health System•Bloomington, MN

1d•Remote

About The Position

The Case Manager plans and coordinates care for patients from pre-admission through post-discharge by working collaboratively with the multidisciplinary team. Ensures that patients are assigned the appropriate level of care, receive the necessary services, and transition smoothly to the appropriate post-discharge setting. Performs accurate, timely, and effective discharge planning. Works with third-party payers to ensure coverage and administer education and prevention programs. ________________________________________ Position Overview: The RN-Case Manager for Primary Care plays a critical role in ensuring seamless patient transitions across care settings. This position involves assessment, care coordination, and communication with patients, families, providers, and payers. The nurse assists with a smooth transition from hospital discharge to care at home and facilitates patient education and safety. ________________________________________

Requirements

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

Nice To Haves

Case Management certification preferred.

Responsibilities

Collaborate local Primary Care offices to assist with patient appointment scheduling.
Collaborate with the multidisciplinary team to develop comprehensive care plans.
Work with third-party payers to verify coverage and facilitate authorization for services.
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, MCCM, and SMS for documentation and communication.