Case Manager RN

Trinity Health; Des Moines (IA); On-site; USD 70,000 - 95,000; Full time

Job summary

MercyOne in Des Moines, IA is seeking an experienced RN Case Manager to join the Care Coordination team. You will partner with physicians, care teams, insurers, and community resources to ensure patients receive the right care at the right time while navigating complex healthcare journeys.

In this role you will review admission status, coordinate services, assist with discharge planning, and connect patients to vital resources.

Qualifications

• Current Iowa RN license required.
• Minimum 5 years of clinical nursing experience required.
• 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.
• Mandatory Reporter Abuse Training required within 3 months of hire.

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.

Skills

Clinical judgment

Critical thinking

Communication

Collaboration

Advocacy

Interdisciplinary teamwork

Education

BSN or healthcare-related degree

Tools

STAR system

Job description

Employment Type:

Full time

Shift:

Night Shift

Description:

Use Your Clinical Expertise Beyond the Bedside

Are you an experienced RN who enjoys critical thinking, collaboration, and advocating for patients? Join MercyOnes 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.

What You'll Do

Drive Patient-Centered Care Coordination

• 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.

Support Utilization Management & Clinical Review

• 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.

Partner Across Teams

• 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.

What Makes This Role Different

Our Care Coordination team is at the heart of patient advocacy and care transitions.

You'll help:

Connect patients with community resources and support services

Coordinate care across inpatient, emergency, and outpatient settings

Facilitate successful discharges and safe transitions of care

Partner with clinical and operational teams to improve outcomes

Support patients in accessing the right care at the right time

This role blends clinical expertise, problem-solving, patient advocacy, and interdisciplinary collaboration into one rewarding career.

What We’re Looking For

We’re seeking an RN who thrives in a collaborative environment and brings:

• Strong clinical judgment and critical thinking skills
• The ability to independently assess complex situations and make sound decisions
• Excellent communication and relationship-building abilities
• A passion for patient advocacy and care coordination
• Comfort working with physicians, payers, and interdisciplinary healthcare teams
• Knowledge of utilization review, payer requirements, and healthcare regulations

Qualifications

• Current Iowa RN license required
• Minimum 5 years of clinical nursing experience required
• 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
• Mandatory Reporter Abuse Training required within 3 months of hire

Why MercyOne?

At MercyOne, you'll be part of a mission-driven team dedicated to improving the health of our communities. Your expertise will directly impact patient experiences, care quality, and health outcomes while offering the stability of a weekday schedule and a collaborative, supportive work environment.

Bring your clinical expertise, passion for advocacy, and commitment to exceptional patient care - and help us guide patients through every step of their healthcare journey.

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.