RN Case Manager – Weekend Admissions & Authorization

MercyOne; Des Moines (IA); On-site; USD 39,000 - 55,000; Part time

Job summary

MercyOne is seeking an RN Case Manager onsite in Iowa to review inpatient and outpatient admission records, collaborate with physicians and Case Management staff, and secure authorizations and continued stay approvals. The role emphasizes payer relations, documentation in the STAR system, and timely communication of status changes.

The position requires an Iowa RN license with at least five years of nursing experience, and a BSN or related degree is preferred.

Qualifications

• Current Iowa RN license.
• Minimum of five years of clinical nursing experience.
• BSN or healthcare-related degree preferred.
• Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care.
• Strong clinical judgment, communication, and independent decision-making skills.

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

Utilization review

Clinical judgment

Communication skills

Independent decision-making

Education

Iowa RN license

BSN or healthcare-related degree preferred

Job description

MercyOne is seeking an RN Case Manager onsite in Iowa to review inpatient and outpatient admission records, collaborate with physicians and Case Management staff, and secure authorizations and continued stay approvals. The role emphasizes payer relations, documentation in the STAR system, and timely communication of status changes.

The position requires an Iowa RN license with at least five years of nursing experience, and a BSN or related degree is preferred.