Case Manager RN

Job summary

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.

Position qualifications

Education [formal]

Licensed registered nurse in the state of Iowa

Bachelor's Degree required. BSN preferred

Utilization management focused certifications that are recognized in the state of Iowa preferred

Experience

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

Case management experience preferred

Special Skills and Competencies

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

MercyOne North Iowa Medical Center Offers

Competitive wages; including 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

All offers are contingent upon the successful completion of references, background checks, pre-employment physical, drug screen and post offer exam.

EEO Employer F/M/Veteran/Disabled

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.