Nurse Senior-Case Management-RN

Posted 17 Days Ago
Be an Early Applicant
Mason City, IA, USA
In-Office
Senior level
Healthtech
The Role
Reviews patient cases, obtains insurance approvals, ensures timely services, facilitates discharge and transitions, and supports compliance with CMS and payer guidelines. Applies care plans, managed-care concepts, utilization criteria, and community resources to improve outcomes and prevent denials. Analyzes data, collaborates with clinical disciplines, exercises independent judgment, and communicates effectively with patients, payers, and healthcare teams.
Summary Generated by Built In
Employment Type:Full timeShift:Day Shift

Description:

POSITION PURPOSE

This Nurse Senior – Case Mgmt – Patient Logistics role ensures alignment with utilization review and case management standards across the patient logistics continuum, driving consistency, regulatory compliance, and best-practice adherence. Through expert guidance and escalation support, the position enhances the quality of placement decisions, positively impacting patient outcomes, throughput, and overall health system performance.FUNCTIONAL ROLE RN III – senior: Practice is guided by nursing process & policy / procedure / standards. Maintains focused area of expertise for care / program & / or provides interventions or knowledge within niche areas of care / program; Advances professional / shared governance, collaborates inter & intra-professionally, delegates to others to advance care, assumes an expanded role & increased responsibility; Able to lead a small team; Serve as a unit / service / program nursing practice mentor & identify learning need of others.

POSITION QUALIFICATIONS

  • Graduation from an accredited school of nursing and Bachelor’s degree is required. Masters Degree in Nursing or related field preferred.
  • Current Iowa RN license, (MercyOne Genesis, excluding Aledo and DeWitt, - current Registered Nurse (RN) license in either Iowa or Illinois is required at the time of hire.
  • A secondary RN license for the other state must be obtained within 12 months of the hire date.) Five (5) years of clinical nursing experience working in Critical Care, Emergency, or acute care hospital is required.
  • Experience must include utilization review or medical necessity review, case management or care transitions, patient placement, bed management or transfer center operations, or acute care coordination across the continuum.
  • Prior experience with Medicare, Medicaid, and commercial payers is preferred.
  • Must be comfortable operating in a collaborative, shared leadership environment.
  • Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health and MercyOne.

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

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.

Skills Required

  • Active registered nurse license in the state of Iowa
  • Bachelor's degree
  • Bachelor of Science in Nursing degree
  • Five years of registered nursing experience involving community contact, managed care, resource utilization criteria, Medicaid, and acute or skilled care insurance coverage
  • Utilization-management-focused certification recognized in Iowa
  • Case management experience
  • Knowledge of data systems, continuous quality improvement, and community healthcare resources
  • Ability to analyze data and exercise independent judgment
  • Effective verbal and written communication skills
  • Critical thinking, initiative, discretion, and decision-making skills
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The Company
HQ: Livonia, MI
6,824 Employees

What We Do

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 Health system includes 88 hospitals, 131 continuing care locations, the second largest PACE program in the country, 125 urgent care locations and many other health and well-being services. Based in Livonia, Michigan, its annual operating revenue is $20.2 billion with $1.2 billion returned to its communities in the form of charity care and other community benefit programs.

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