Employment Type:

Full time

Shift:

Day Shift

Description:

JOB SUMMARY

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.

POSITION QUALIFICATIONS

Education [formal]:

• 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

Special Skills and Competencies:

• Knowledge/skills with data systems, continuous quality improvement (CQI), community healthcare resources

• Ability to work independently in analyzing data, exercising judgment to arrive at conclusions

• Ability to establish and maintain working relationships

• Assertiveness and critical thinking

• Ability to communicate effectively and tactfully both verbally and in writing

• Skill in exercising a high degree of initiative, judgment, discretion, and decision-making

• Ability to plan, prioritize, organize and direct the work of others

• Ability to communicate clearly and effectively

• Willingness to accept responsibility and to be accountable for own actions

MercyOne North Iowa Medical Center Offers:

• Competitive wages; including weekend and night differentials

• Benefit Package (Blue Cross Blue Shield of Michigan) for positions 16 hours per week or greater

• Educational assistance

• Success Sharing - a bonus when the organization meets its goals

All offers are contingent upon the successful completion of references, background checks, pre-employment physical, drug screen and post offer exam.

EEO Employer F/M/Veteran/Disabled

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.