RN Case Manager-PRN

IU Health is seeking a compassionate, collaborative, and clinically experienced RN Case Manager to support both IU Health North Hospital and IU Health Fishers Hospital on a true PRN basis. In this role, you will serve as a key member of the interdisciplinary care team, facilitating coordinated, patient-centered care across the continuum from admission through post-discharge.

Responsibilities

• Coordinate and manage patient care throughout the continuum, from pre-admission through discharge and post-acute transition planning.
• Collaborate with physicians, nursing staff, social workers, and other members of the multidisciplinary healthcare team to develop and implement individualized care plans.
• Assess and validate appropriate patient status and level of care using established clinical criteria and regulatory guidelines.
• Facilitate timely and effective discharge planning to ensure safe transitions to the appropriate post-acute setting.
• Coordinate referrals and access to community resources, home health services, rehabilitation, skilled nursing, and other post-discharge services as needed.
• Work with third-party payers and insurance providers to ensure appropriate authorization, coverage, and reimbursement for services.
• Monitor utilization of healthcare resources and support regulatory compliance initiatives.
• Participate in denial management and appeals processes when applicable.
• Provide patient and family education related to care coordination, discharge planning, disease prevention, and available resources.
• Maintain accurate and timely documentation in accordance with organizational, regulatory, and payer requirements.

Qualifications

• Associate's Degree in Nursing required. BSN preferred.
• Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license.
• Certification in Case Management preferred.
• Knowledge of InterQual Acute Level of Care Criteria and Federal guidelines outlining coverage of inpatient and outpatient hospital services, including observation is preferred.
• Knowledge of Medicare/Medicaid, insurance and regulatory guidelines is preferred.
• Ability to comprehend third party contractual arrangements is preferred.
• Understanding of the third party denial and appeal process is preferred.
• Requires knowledge of various software applications including Windows; Cerner; MCCM; and SMS.
• 3-5 years of experience required.
• Requires strong clinical background in acute care.

Schedule

PRN (As Needed) | Variable Schedule