ER Case Manager RN Weekends

MercyOne; Des Moines (IA); On-site; USD 65,000 - 90,000; Full time

Job summary

Mercy Medical Center in Des Moines, IA is seeking an RN Case Manager to review inpatient and outpatient admissions, collaborate with physicians and Case Management, and facilitate authorization with payers. This onsite role involves cross-department coordination to ensure accurate payer source and proper admission status.

The position emphasizes utilization review, evidence-based criteria, and timely communication with departments to support patient care and continued stay approvals.

Qualifications

• Current Iowa RN license.
• At least 5 years of clinical nursing experience.
• Knowledge of insurance eligibility, CMS rules, and utilization review processes.
• Utilization Review certification within 12 months of hire preferred.
• Mandatory Reporter abuse training within 3 months of hire.

Responsibilities

• Perform admission, concurrent, and post-discharge utilization reviews.
• Apply Milliman Care Guidelines and payer criteria to determine patient status.
• Collaborate with attending physicians to clarify admission status and initiate second-level reviews as needed.
• Communicate status changes promptly to Case Management, Admitting, and other relevant departments.
• Provide patient/family education and issue Notices of Status Change when required.
• Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system.
• Submit timely clinical information to payers to prevent technical denials and support authorization and continued stay.
• Review and route denial notifications for appeal consideration; collaborate with post-denials, RAC, and appeal teams.
• Monitor insurance coverage and communicate updates to verification and financial teams.
• Participate in peer-to-peer reviews and advocate for appropriate admission status and continued stay.

Skills

Clinical judgment

Communication

Independent decision-making

Education

BSN or healthcare-related degree

Job description

Shift:

Weekends: Saturday and Sunday 7am - 7:30 PM

General Summary:

Responsible for the review of inpatient and outpatient admission records for appropriate admission status at Mercy Medical Center and Mercy West Lakes. Works in collaboration with the attending physician and the Case Management staff utilizing admission criteria guidelines-and second level physician review process when appropriate. Interacts with insurance providers to obtain authorization and continued stay approval for admission. Collaborates with the Verification department, Revenue cycle and Medical Eligibility to facilitate the establishment of the correct payer source for patient stay and the documentation of the interactions in the STAR admitting system

Shift:Full timeShift:Weekend ShiftDescription:RN Case Manager (Onsite)

Shift:

Weekends: Saturday and Sunday 7am - 7:30 PM

General Summary:

Responsible for the review of inpatient and outpatient admission records for appropriate admission status at Mercy Medical Center and Mercy West Lakes. Works in collaboration with the attending physician and the Case Management staff utilizing admission criteria guidelines-and second level physician review process when appropriate. Interacts with insurance providers to obtain authorization and continued stay approval for admission. Collaborates with the Verification department, Revenue cycle and Medical Eligibility to facilitate the establishment of the correct payer source for patient stay and the documentation of the interactions in the STAR admitting system

Key Responsibilities

• Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements.

• Apply Milliman Care Guidelines and payer-specific criteria to determine appropriate patient status.

• Collaborate with attending physicians to clarify admission status and initiate second-level physician reviews as needed.

• Communicate status changes promptly to Case Management, Admitting, and other relevant departments.

• Provide patient/family education and issue Notices of Status Change when required.

• Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system.

• Submit timely clinical information to payers to prevent technical denials and support authorization and continued stay.

• Review and route denial notifications for appeal consideration; collaborate with post-denials, RAC, and appeal teams.

• Monitor insurance coverage and communicate updates to verification and financial teams.

• Participate in peer-to-peer reviews and advocate for appropriate admission status and continued stay.

Qualifications

• Current Iowa RN license.

• Minimum of five (5) years of clinical nursing experience.

• BSN or healthcare-related degree preferred.

• Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care.

• Strong clinical judgment, communication, and independent decision-making skills.

• Utilization Review certification within 12 months of hire preferred.

• Completion of Mandatory Reporter abuse training within three (3) months of hire.

Work Environment & Physical Requirements

• Primarily office-based with computer, phone, and documentation tasks.

• Light physical activity with occasional lifting; use of assistive devices and additional personnel as required.

• Visual acuity sufficient to review medical records and electronic systems.

• Ability to work collaboratively in a fast-paced, high-stress healthcare environment while maintaining professionalism and courtesy.

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.