Position Purpose:
The Utilization Review Case Manager responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services. Assists the organization in ensuring compliance with CMS rules and regulations and conditions of participation as well as commercial payer specific guidelines to prevent denials and revenue loss. Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines.
Hours/Schedule:
PRN/ As needed/ no weekends or holidays
Minimum Qualifications:
Education
Licensed registered nurse in the state of Iowa.
Bachelor's Degree required. BSN preferred
Utilization management focused certifications that are recognized in the state of Iowa preferred
Experience:
Five years of experience as a registered nurse involving community contact, knowledge of managed care, resource utilization criteria, Medicaid, insurance coverage for acute care and skilled care
Case management experience preferred
Position Highlights and Benefits:
Education Assistance offered
Effective Day 1 Benefit Package (Medical, Dental, Vision, and more) for positions 16 hours per week or greater
Competitive wages; including weekend and night differentials
Generous paid time off program
Retirement Savings program with employer match starting on Day 1
Ministry/Facility Information:
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 260,000.
With more than 3,000 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 Iowa’s largest multispecialty clinic systems. In north Iowa, our clinics are made up of more than 25 primary care, pediatric, internal medicine and specialty clinics.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.
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