Utilization Review Case Manager - Inpatient - Full Time - Mason City Iowa

Company: MercyOne
Location: Mason City, Iowa
Posted On: 05/10/2025

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.What you will do:

• Works directly with members of care team to effectively ensure appropriate acute utilization management
• Interacts with outside review agencies and payors to inform them of extended stay plan and necessity of services for complex cases
• Assures all appropriate clinical information is provided to outside agencies to secure authorizations
• Reviews new admissions to ensure charts are analyzed for medical necessity and assures follow up of continued stays
• Performs resource management for identified patients by confirming and coordinating benefits and resources appropriate for the patient and family including age appropriate considerations
• Accurately and completely documents clinical reviews in accordance with documentation standards, policies, procedures and/or guidelinesMinimum Qualifications:
  • Licensed registered nurse in the state of Iowa.
  • Bachelor's Degree required. BSN preferred or willing to obtain within 5 years of hire
  • 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
  • Must provide proof of Basic Life Support (BLS Provider-American Heart Association or Professional Rescuer-American Red Cross) prior to employment or within 30 days of hire and maintains current status.
  • Must provide proof of Mandatory Reporting for Child and Dependent Adult Abuse training prior to employment or within 6 months of hire and maintain current status. Highlights and Benefits:
    • Relocation Stipend offered to those relocating 50 miles or greater
    • 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 1Ministry/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. More...

          

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