RN Care Manager: Discharge & Utilization Specialist

IRMC; Indiana (PA); On-site; USD 70,000 - 100,000; Full time

Job summary

IRMC in Pennsylvania seeks an experienced RN Case Manager to collaborate with nursing and case management leadership. You will determine insurance eligibility, assess medical necessity, and coordinate discharge planning with patients, families, and the health care team.

Responsibilities include communicating with staff on referrals, authorizations, and coverage criteria, ensuring efficient patient movement, and supporting ongoing cost-effective care across the continuum.

Qualifications

• 3–5 years medical/surgical nursing experience.
• Case management experience in Acute, Psychiatric, or ED.
• Licensure as RN in Pennsylvania.
• Case Manager Certification preferred.

Responsibilities

• Collaborate with nursing and case management leadership to meet patient care goals.
• Determine patient insurance eligibility, status, and benefit coverage.
• Assess medical necessity and appropriateness of admission and continued stay.
• Coordinate discharge planning and resource continuation with care teams.
• Communicate with staff regarding referrals, authorizations, and criteria.
• Document and maintain patient information in the software system.

Skills

Case management

Medicare/MA/MCO knowledge

Interqual or Milliman experience

Discharge planning

Communication with medical staff

Education

Nursing or health-related degree

Tools

Microsoft Office

Job description

IRMC in Pennsylvania seeks an experienced RN Case Manager to collaborate with nursing and case management leadership. You will determine insurance eligibility, assess medical necessity, and coordinate discharge planning with patients, families, and the health care team.

Responsibilities include communicating with staff on referrals, authorizations, and coverage criteria, ensuring efficient patient movement, and supporting ongoing cost-effective care across the continuum.