Night RN Case Manager — Utilization & Care Coordination

MercyOne; Des Moines (IA); On-site; USD 70,000 - 90,000; Full time

Job summary

Mercy Medical Center in Des Moines, IA seeks an experienced RN Case Manager for full-time night shifts to review admissions, coordinate utilization management, and secure payer authorizations. The role collaborates with physicians, case management, and revenue cycle teams to ensure accurate status and documentation in STAR system.

Onsite office-based position with rotating weekends. Requirements include Iowa RN license, 5+ years clinical nursing, knowledge of CMS rules and utilization review;

Qualifications

• Current Iowa RN license.
• Minimum of five (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.
• Completion of Mandatory Reporter abuse training within three (3) months of hire.

Responsibilities

• Perform admission, concurrent, and post-discharge utilization reviews per 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 reviews as needed.
• Communicate status changes promptly to Case Management, Admitting, and other departments.
• Provide patient/family education and issue Notices of Status Change when required.
• Document utilization review activities and authorizations in the medical record and STAR system.
• Submit clinical information to payers to prevent denials and support authorization and continued stay.
• Route denial notifications for appeal and collaborate with post-denials teams.
• Monitor insurance coverage and update verification and financial teams.
• Participate in peer-to-peer reviews to advocate for appropriate admission status.

Education

Current Iowa RN license

BSN or healthcare-related degree preferred

Job description

Mercy Medical Center in Des Moines, IA seeks an experienced RN Case Manager for full-time night shifts to review admissions, coordinate utilization management, and secure payer authorizations. The role collaborates with physicians, case management, and revenue cycle teams to ensure accurate status and documentation in STAR system.

Onsite office-based position with rotating weekends. Requirements include Iowa RN license, 5+ years clinical nursing, knowledge of CMS rules and utilization review;