RN Utilization Review Case Manager | Care Coordination

MercyOne Medical Group; Mason City (IA); On-site; USD 70,000 - 90,000; Full time

Job summary

MercyOne North Iowa Medical Center in Mason City, IA is seeking a full-time Utilization Review Case Manager RN for day shift. You will screen cases, secure insurance approval, and ensure timely services, with discharge planning and transition to appropriate services.

You will help ensure CMS compliance and payer guidelines, applying care plans and managed care concepts while coordinating with clinical teams and leveraging community resources.

Qualifications

• Licensed RN in Iowa is required.
• Five years of RN experience with community contact and management of care.
• BSN preferred; utilization management certifications preferred.

Responsibilities

• Case screening and insurance approval, ensuring timely services.
• Facilitate discharge with transition to appropriate services.
• Ensure CMS rules and payer guidelines compliance to avoid denials.
• Achieve patient outcomes via care plans, managed care concepts, and resource management.
• Collaborate with clinical disciplines and utilize community resources.

Skills

RN license

Case management

Data systems

CQI

Communication

Education

RN license in Iowa

BSN preferred

Utilization management certifications preferred

Job description

MercyOne North Iowa Medical Center in Mason City, IA is seeking a full-time Utilization Review Case Manager RN for day shift. You will screen cases, secure insurance approval, and ensure timely services, with discharge planning and transition to appropriate services.

You will help ensure CMS compliance and payer guidelines, applying care plans and managed care concepts while coordinating with clinical teams and leveraging community resources.