Weekend RN Case Manager – Utilization & Discharge Liaison

Trinity Health Mid-Atlantic; West Des Moines (IA); On-site; USD 70,000 - 100,000; Full time

Job summary

Trinity Health is seeking an RN Case Manager to perform admission, concurrent, and post-discharge utilization reviews onsite in Iowa. You will apply guidelines, collaborate with physicians, and ensure timely communications with departments and payers to support appropriate admission status and continued stay.

Ideal candidates have 5+ years of clinical nursing experience, an Iowa RN license, and a BSN or healthcare-related degree.

Qualifications

• Current Iowa RN license.
• Minimum of five (5) 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.
• Utilization Review certification within 12 months of hire preferred.
• Completion of Mandatory Reporter abuse training within three (3) months of hire.

Responsibilities

• Perform admission, concurrent, and post-discharge utilization reviews per UM Plan and regulatory requirements.
• Apply Milliman Care Guidelines and payer criteria to determine patient status.
• Collaborate with attending physicians to clarify admission status and initiate second-level physician reviews.
• Communicate status changes promptly to Case Management, Admitting, and other relevant departments.
• Provide patient/family education and issue Notices of Status Change when required.
• Document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system.
• Submit clinical information to payers to prevent denials and support authorization and continued stay.
• Review and route denial notifications for appeal; 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

RN licensure

Utilization review

Communication

Independent decision making

Education

BSN or healthcare-related degree

Job description

Trinity Health is seeking an RN Case Manager to perform admission, concurrent, and post-discharge utilization reviews onsite in Iowa. You will apply guidelines, collaborate with physicians, and ensure timely communications with departments and payers to support appropriate admission status and continued stay.

Ideal candidates have 5+ years of clinical nursing experience, an Iowa RN license, and a BSN or healthcare-related degree.