Case Manager-RN

Employment Type:

Shift:

Position Summary:

-TheUtilization Review(UR)Case Manager – Post-Acute Prior Authorization role performsUtilization Reviewactivities and serves as thecentral coordinator forpost‑acuteprior authorizations (PAs)for skilled nursing, swing bed, CAH swing, acute rehab, LTACH, and otherpost‑acutelevels of care.
-This role drivestimelyauthorization determinations, reducesauthorization‑relateddelays, supports throughput goals, decreases avoidable inpatient days, and helps ensure efficient discharge planning.
Responsibilities include PA submission andfollow‑up,denial‑preventionsupport, external notifications, data extraction from the chart, Epic work queue tasks, supporting second IMM processes as needed, coordination with payers andpost‑acutefacilities, andassists with other appropriateadministrative support for the acute care management team.

Essential Functions:

1)Post‑AcutePrior Authorization Management (Primary Function)

• Centralizes,submits, monitors, and follows up onpost‑acuteprior authorizationsusing payer portals, phone calls, and clinical documentation workflows.

• Ensurescomplete andaccurateclinical packets; escalates delays when authorization timelines exceed expectations.

• Documents all PA activity in Epic andmaintainstandardized PA workflows for consistency and efficiency.

• Communicates PA status and clinical needs topost‑acutefacilities, payers, case managers, social workers, andfellowURRNs.

• Provides external notification of discharges andpost‑acutetransfers.

• Supports implementation and evaluation of the centralized PA workflow, includingestablishinga regular cadence foroutcome monitoring.

2)Utilization Review& Denial Prevention Support

• Extracts meaningful data from the medical record to support URRNclinical reviews.

• Identifiespotential concurrent denials and routes information to URRNs promptly.

*For full list of responsibilities please request job description*

Minimum Qualifications:

• Education & Licensure

  • Must be one of the following:

  • Registered Nurse (RN)with anactive, unrestricted license

  • Bachelor of Science in Nursing (BSN)strongly preferred

  Experience

  • Minimumfiveyears of directRNpracticerequired.

  • Prior experience interacting with insurance companies, payers, or care partners—or a strong interest in learning how to navigate authorization processes and advocate fortimely,appropriate patientdischarges—is preferred.

  Certifications

  • Basic Life Support (BLS)within60 daysofhire;mustmaintaincertification.

  • Mandatory Reporter – Child & Dependent Adult Abusewithin6 monthsof hire; renewal per policy.

  Knowledge, Skills & Abilities

  • Strong organizational andtime‑managementskills;detail‑oriented.

  • Proficient in email, internet navigation, payer portals, and Microsoft Excel and Word.

  • Ability to multitask and work independently while collaborating with multidisciplinary teams.

  • Strongcustomer‑serviceskills aligned withMercyOnemission and values.

We care about your well-being, both physical and mental, which is why our benefit package includes:

• Wellness programs

• Education reimbursement

• Personalized health insurance plans (including dental and vision)

• PTO

• Long- and short-term leave

• Retirement planning

• Life insurance coverage

Ministry/Facility Information:

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

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 dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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.