• Job Description

  Req#: 151367

  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

  #RYCJessi

• About the company

  Welcome to UnityPoint Health. As your partner in health, we're dedicated to making it easier for you to live well-so you can show up for the moments that matter most.

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