Case Manager RN Weekend Days

About the role

Part-time weekend position (Saturday and Sunday, 7:00 AM–7:30 PM) as an RN Case Manager (Onsite) at Mercy Medical Center and Mercy West Lakes. Responsible for reviewing inpatient and outpatient admission records for appropriate admission status, collaborating with attending physicians and case management staff, interacting with insurance providers for authorization and continued stay approval, and working with verification, revenue cycle, and medical eligibility teams to establish correct payer source and document interactions in the STAR admitting system.

Responsibilities

• Perform admission, concurrent, and post‑discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements.
• Apply Milliman Care Guidelines and payer‑specific criteria to determine appropriate patient status.
• Collaborate with attending physicians to clarify admission status and initiate second‑level physician reviews as needed.
• Communicate status changes promptly to Case Management, Admitting, and other relevant departments.
• Provide patient/family education and issue Notices of Status Change when required.
• Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system.
• Submit timely clinical information to payers to prevent technical denials and support authorization and continued stay.
• Review and route denial notifications for appeal consideration; collaborate with post‑denials, RAC, and appeal teams.
• Monitor insurance coverage and communicate updates to verification and financial teams.
• Participate in peer‑to‑peer reviews and advocate for appropriate admission status and continued stay.

Requirements

• Current Iowa RN license.
• Minimum of five (5) years of clinical nursing experience.
• BSN or healthcare‑related degree preferred.
• Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care.
• Utilization Review certification within 12 months of hire preferred.
• Completion of Mandatory Reporter abuse training within three (3) months of hire.

Skills

• Strong clinical judgment.
• Effective communication.
• Independent decision‑making.
• Ability to work collaboratively in a fast‑paced, high‑stress healthcare environment while maintaining professionalism and courtesy.

Schedule

Weekends: Saturday and Sunday, 7:00 AM – 7:30 PM.