Night Shift RN Case Manager: Care Coordination Champion

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

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.