Case Manager-RN
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Job Location:
Mason City, IL - USA
Monthly Salary:
Not Disclosed
Posted on:
7 hours ago
Vacancies:
1 Vacancy
Job Summary
Employment Type:
Full timeShift:
Day ShiftDescription:
Full Time Days
8-hour shifts
Position Summary:
-TheUtilization Review(UR)Case Manager Post-Acute Prior Authorization role performsUtilization Reviewactivities and serves as thecentral coordinator forpostacuteprior authorizations (PAs)for skilled nursing swing bed CAH swing acute rehab LTACH and otherpostacutelevels of care.
-This role drivestimelyauthorization determinations reducesauthorizationrelateddelays supports throughput goals decreases avoidable inpatient days and helps ensure efficient discharge planning.
Responsibilities include PA submission andfollowupdenialpreventionsupport external notifications data extraction from the chart Epic work queue tasks supporting second IMM processes as needed coordination with payers andpostacutefacilities andassists with other appropriateadministrative support for the acute care management team.
Essential Functions:
1)PostAcutePrior Authorization Management (Primary Function)
Centralizessubmits monitors and follows up onpostacuteprior authorizationsusing payer portals phone calls and clinical documentation workflows.
Ensurescomplete andaccurateclinical packets; escalates delays when authorization timelines exceed expectations.
Documents all PA activity in Epic andmaintainstandardized PA workflows for consistency and efficiency.
Communicates PA status and clinical needs topostacutefacilities payers case managers social workers andfellowURRNs.
Provides external notification of discharges andpostacutetransfers.
Supports implementation and evaluation of the centralized PA workflow includingestablishinga regular cadence foroutcome monitoring.
2)Utilization Review& Denial Prevention Support
Extracts meaningful data from the medical record to support URRNclinical reviews.
Identifiespotential concurrent denials and routes information to URRNs promptly.
*For full list of responsibilities please request job description*
Minimum Qualifications:
Education & Licensure
Must be one of the following:
Registered Nurse (RN)with anactive unrestricted license
Bachelor of Science in Nursing (BSN)strongly preferred
Experience
Minimumfiveyears of directRNpractice.
Prior experience interacting with insurance companies payers or care partnersor a strong interest in learning how to navigate authorization processes and advocate fortimelyappropriate patientdischargesis preferred.
Certifications
Basic Life Support (BLS)within60 daysofhire;mustmaintaincertification.
Mandatory Reporter Child & Dependent Adult Abusewithin6 monthsof hire; renewal per policy.
Knowledge Skills & Abilities
Strong organizational andtimemanagementskills;detailoriented.
Proficient in email internet navigation payer portals and Microsoft Excel and Word.
Ability to multitask and work independently while collaborating with multidisciplinary teams.
Strongcustomerserviceskills aligned withMercyOnemission and values.
We care about your well-being both physical and mental which is why our benefit package includes:
Wellness programs
Education reimbursement
Personalized health insurance plans (including dental and vision)
PTO
Long- and short-term leave
Retirement planning
Life insurance coverage
Ministry/Facility Information:
Trinity Health is a family of 115000 colleagues and nearly 26000 physicians and clinicians across 25 states. Because we serve diverse populations our colleagues are trained to recognize the cultural beliefs values traditions language preferences and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
MercyOne North Iowa Medical Center provides expert health care to 15 counties. MercyOne North Iowa Medical Center is a 342 bed regional referral teaching hospital in Mason City Iowa. MercyOne New Hampton Medical Center is an 11 bed rural access hospital in New Hampton Iowa. Our service area spans 15 counties across northern Iowa and southern Minnesota. We serve a population over 260000.
With more than 3000 colleagues and a medical staff of almost 500 physicians and allied health professionals MercyOne North Iowa Medical Center is the largest employer in the region.
MercyOne Medical Group North Iowa is part of Iowas largest multispecialty clinic north Iowa our clinics are made up of more than 25 primary care pediatric internal medicine and specialty clinics.
Our dedication to diversity includes a unified workforce (through training and education recruitment retention and development) commitment and accountability communication community partnerships and supplier diversity.
Our Commitment
Rooted in our Mission and Core Values we honor the dignity of every person and recognize the unique perspectives experiences and talents each colleague brings. By finding common ground and embracing our differences we grow stronger together and deliver more compassionate person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability veteran status or any other status protected by federal state or local law.
Required Experience:
Manager
About Company
Trinity Health is one of the largest not-for-profit, Catholic health care systems in the nation. It is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians caring for diverse communities across 25 states. Nationally recognized for care and experience, the Trinity ... View more
