RN Case Manager-PRN

Indiana University Health; Carmel (AR); On-site; USD 70,000 - 90,000; Full time

Job summary

Indiana University Health is seeking an experienced RN Case Manager on a PRN basis to support IU Health North Hospital and IU Health Fishers Hospital. You will coordinate patient care across the continuum, from admission through post-discharge, ensuring appropriate levels of care and efficient utilization of services.

You will collaborate with physicians, nursing staff, social workers, payers, and community resources to develop individualized care plans and safe transitions.

Qualifications

• Associate's Degree in Nursing required; BSN preferred.
• Active RN license in Indiana or NLC RN license.
• Certification in Case Management preferred.
• Knowledge of InterQual Acute Level of Care Criteria and Federal guidelines preferred.
• Knowledge of Medicare/Medicaid and regulatory guidelines preferred.
• Experience with third-party payer contracts and denial/appeal processes preferred.
• Familiarity with Cerner, MCCM, SMS and Windows software.

Responsibilities

• Coordinate and manage patient care across the continuum from admission to post-discharge.
• Collaborate with physicians, nursing staff, social workers, payers, and community resources.
• Assess patient status and determine level of care using clinical criteria and guidelines.
• Facilitate discharge planning and transitions of care to appropriate post-acute settings.
• Coordinate referrals to home health, rehab, SNF and other post-discharge services.
• Work with payers to obtain authorization and ensure coverage and reimbursement.
• Monitor resource utilization and support regulatory compliance initiatives.
• Participate in denial management and appeals when applicable.
• Educate patients and families on care coordination, discharge planning, disease prevention, and available resources.
• Maintain timely and accurate documentation per requirements.

Skills

Clinical case management

Care coordination

Payer coordination

Regulatory compliance

Discharge planning

Denial management

Documentation

Strong communication

Education

Associate's Degree in Nursing

RN license in Indiana or NLC

BSN preferred

Case Management certification preferred

Tools

Cerner

MCCM

SMS

Windows

Job description

Registered Nurse (RN) Case Manager - PRN

Location: IU Health North Hospital & IU Health Fishers Hospital
Schedule: PRN (As Needed) | Variable Schedule

Overview

IU Health is seeking a compassionate, collaborative, and clinically experienced RN Case Manager to support both IU Health North Hospital and IU Health Fishers Hospital on a true PRN basis. In this role, you will serve as a key member of the interdisciplinary care team, facilitating coordinated, patient-centered care across the continuum from admission through post-discharge.

The RN Case Manager is responsible for assessing patient needs, ensuring appropriate levels of care, coordinating transitions of care, and developing effective discharge plans that support positive patient outcomes. This role works closely with physicians, nursing staff, social workers, payers, and community resources to promote efficient utilization of healthcare services while maintaining the highest standards of quality and patient satisfaction.

Key Responsibilities

• Coordinate and manage patient care throughout the continuum, from pre-admission through discharge and post-acute transition planning.
• Collaborate with physicians, nursing staff, social workers, and other members of the multidisciplinary healthcare team to develop and implement individualized care plans.
• Assess and validate appropriate patient status and level of care using established clinical criteria and regulatory guidelines.
• Facilitate timely and effective discharge planning to ensure safe transitions to the appropriate post-acute setting.
• Coordinate referrals and access to community resources, home health services, rehabilitation, skilled nursing, and other post-discharge services as needed.
• Work with third-party payers and insurance providers to ensure appropriate authorization, coverage, and reimbursement for services.
• Monitor utilization of healthcare resources and support regulatory compliance initiatives.
• Participate in denial management and appeals processes when applicable.
• Provide patient and family education related to care coordination, discharge planning, disease prevention, and available resources.
• Maintain accurate and timely documentation in accordance with organizational, regulatory, and payer requirements.

Qualifications

• Associate's Degree in Nursing required. BSN preferred.
• Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license.
• Certification in Case Management preferred.
• Knowledge of InterQual Acute Level of Care Criteria and Federal guidelines outlining coverage of inpatient and outpatient hospital services, including observation is preferred.
• Knowledge of Medicare/Medicaid, insurance and regulatory guidelines is preferred.
• Ability to comprehend third party contractual arrangements is preferred.
• Understanding of the third party denial and appeal process is preferred.
• Requires knowledge of various software applications including Windows; Cerner; MCCM; and SMS.
• 3-5 years of experience required.
• Requires strong clinical background in acute care.

• Indiana University Health has nearly 40,000 team members, including more than 3,600 physicians and 1,200 advanced practice providers, and we're home to the largest nursing network in Indiana with more than 9,000 nursing team members at over 800 sites of care.
• IU Health is ranked No. 1 in Indiana by U.S. News & World Report, Riley Children's Health is ranked among the top children's hospitals in the country by U.S. News & World Report.
• A unique partnership with the Indiana University School of Medicine - one of the nation’s largest medical schools - gives patients access to groundbreaking research and innovative treatments, and it offers team members access to the latest science and the very best training - advancing healthcare for all.
• With 15 hospitals, including seven with Magnet designation and eight with Pathways to Excellence designation, our team members are leading the way through excellence.
• At Indiana University Health, your personal and professional growth is a top priority. You will have access to many diverse opportunities to learn and develop in meaningful ways that matter most to you, such as advanced clinical training, leadership development, promotion opportunities and cross training development.
• Indiana University Health is invested in the lives of Hoosiers, leading the transformation of healthcare to make Indiana one of the nation’s healthiest states.