Overview

Join our dynamic team at UnityPoint Health as a Managed Care RN - Case Manager!

Location: Remote or Hybrid (Based on Experience)

Hours: Full-Time, Monday-Friday, 8:00 AM - 5:00 PM

What You’ll Do:

• Coordinate Care: Collaborate with interdisciplinary teams to ensure patients receive the right care at the right time.
• Manage Utilization: Handle payment authorizations, clinical coordination, and discharge planning.
• Support Patients: Monitor plans of care, address needs, and facilitate community resources.

Why UnityPoint Health?

• Commitment to our Team – For the third consecutive year, we're proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare for our commitment to our team members.
• Culture – At UnityPoint Health, you matter. Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
• Benefits – Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.
• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
• Development – We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.

Visit https://dayinthelife.unitypoint.org/ to hear more from our team members about why UnityPoint Health is a great place to work.

Responsibilities

• Performs utilization and case management reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources and payment approval.
• Requests reviews with physician advisors, and/or Executive Health Resources (EHR), as appropriate, if admission or continued stay criteria are not met, assuring appropriate and timely level of care status.
• Conducts payment authorizations and coordinated payment denials while meeting timeliness guidelines.
• Ensures case coordination with client’s health care providers.
• Provides utilization management and case management to designated enrollees. Assuring that all enrollees receive clinically sound triage/referral and ongoing care management services for medical needs.

Qualifications

Education:

• Registered Nurse
• CCM (Certified Case Manager)

Experience:

• 5+ years of nursing experience
• Insurance experience on the company side is required.

License(s)/Certification(s):

• Compact Nursing License / or licensed behavioral health clinician. Required Illinois and Iowa licenses within first 90 days of hire

Knowledge/Skills/Abilities:

• Professional Communication – written & verbal
• Customer/patient focused
• Self-motivated
• Managing priorities/deadlines
• Flexibility to adapt to changing priorities or needs
• Planning and organizing skills
• MS Office proficiency (Outlook, Word)
• Ability to give work direction to non-clinical staff

#RYCJessi

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