Onsite RN Case Manager — Weekdays, Full-Time

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

Job summary

Mercy Medical Center is seeking an RN Case Manager to work onsite in Des Moines. You will review inpatient and outpatient admission records, collaborate with physicians and Case Management staff to ensure appropriate status, and coordinate with payers for authorization and continued stay.

You will interface with Verification, Revenue Cycle, and Medical Eligibility to document interactions in the STAR system and ensure accurate payer sources and timely communications.

Qualifications

• Current Iowa RN license.
• Minimum of five (5) years of clinical nursing experience.
• BSN or healthcare-related degree preferred.
• 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 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.

Skills

RN license

Communication

Clinical judgment

Independent decision-making

Utilization review knowledge

Education

BSN preferred

Healthcare-related degree

Job description

Mercy Medical Center is seeking an RN Case Manager to work onsite in Des Moines. You will review inpatient and outpatient admission records, collaborate with physicians and Case Management staff to ensure appropriate status, and coordinate with payers for authorization and continued stay.

You will interface with Verification, Revenue Cycle, and Medical Eligibility to document interactions in the STAR system and ensure accurate payer sources and timely communications.