RN Utilization Review Case Manager – Day Shift

Trinity Health; Mason City (IA); On-site; USD 85,000 - 110,000; Full time

Job summary

MercyOne North Iowa Medical Center seeks a qualified Utilization Review Case Manager (RN) to screen cases, obtain insurance approvals, and ensure timely services with discharge planning to appropriate settings. You will help ensure CMS compliance and adherence to payer guidelines to prevent denials and revenue loss.

Ideal candidates hold Iowa RN licensure with a Bachelor's degree (BSN preferred) and five years of RN experience in managed care or community settings.

Qualifications

• Licensed RN in Iowa required.
• Bachelor's degree required.
• BSN preferred.
• Utilization management certifications recognized in Iowa preferred.
• Five years RN experience involving community contact, managed care, resource utilization and Medicaid/insurance.
• Case management experience preferred.
• Knowledge of data systems and CQI; familiarity with community resources.

Responsibilities

• Screen cases for utilization review and obtain insurance approvals.
• Ensure timely services and discharge planning with transition to appropriate services.
• Help ensure CMS compliance and payer guidelines to prevent denials and revenue loss.
• Collaborate with clinical disciplines to apply care plans and manage resources.

Skills

Case management

Managed care

Data analysis

Communication

Independent work

Judgment & decision-making

Collaboration

Education

Bachelor's Degree

BSN preferred

Tools

EMR systems

Care coordination software

Job description

MercyOne North Iowa Medical Center seeks a qualified Utilization Review Case Manager (RN) to screen cases, obtain insurance approvals, and ensure timely services with discharge planning to appropriate settings. You will help ensure CMS compliance and adherence to payer guidelines to prevent denials and revenue loss.

Ideal candidates hold Iowa RN licensure with a Bachelor's degree (BSN preferred) and five years of RN experience in managed care or community settings.