Case Manager

Case Manager-PRN

The Case Manager plans and coordinates care for patients from pre-admission through post-discharge by working collaboratively with the multidisciplinary team. Ensures that patients are assigned the appropriate level of care, receive the necessary services, and transition smoothly to the appropriate post-discharge setting. Performs accurate, timely, and effective discharge planning. Works with third-party payers to ensure coverage and administer education and prevention programs.

The RN-Case Manager plays a critical role in ensuring seamless patient transitions across care settings. This position involves assessment, care coordination, and communication with patients, families, providers, and payers. The nurse develops individualized discharge plans, manages insurance coverage, and facilitates patient education and safety.

Key Responsibilities:

• Plan and coordinate patient care from pre-admission through post-discharge, ensuring appropriate levels of care and services.
• Perform accurate and timely discharge planning, including documentation and communication.
• Collaborate with the multidisciplinary team to develop comprehensive care plans.
• Work with third-party payers to verify coverage and facilitate authorization for services.
• Educate patients and families on post-discharge care, safety, and prevention strategies.
• Assist with third-party denials, appeals, and understanding contractual arrangements.
• Ensure compliance with Medicare, Medicaid, insurance, and regulatory guidelines.
• Utilize various software applications including Windows, Cerner, MCCM, and SMS for documentation and communication.

Qualifications & Requirements:

• Education: Associate's Degree in Nursing required. RNs hired after January 1, 2013, must complete their BSN within 5 years of hire.
• Licensure: Active RN license in Indiana or Nurse Licensure Compact (NLC).
• Certifications: Case Management certification preferred.
• Experience: 3-5 years of clinical experience in acute care required.
• Knowledge & Skills: Knowledge of InterQual Acute Level of Care Criteria and federal coverage guidelines is preferred. Familiarity with Medicare/Medicaid, insurance, and regulatory guidelines is preferred. Ability to understand third-party contractual arrangements and denial/appeal processes is advantageous. Proficiency with Windows, Cerner, MCCM, SMS, and other relevant software applications.
• Core Competencies:
• Connect to Promise: Demonstrates commitment to IU Health's mission, vision, and values by exhibiting behaviors and delivering results aligned with the organization's strategic goals. Focuses on improving the health of all Hoosiers through purpose, excellence, compassion, and teamwork.
• Collaboration: Coordinates activities with team members and leaders. Seeks out and shares best practices to improve performance.
• Relationship Building & Customer Care: Maintains respectful, courteous, and helpful relationships with internal and external customers. Demonstrates appreciation for customer needs and expectations. Reflects an attitude of responsiveness and service.
• Communication: Clearly expresses ideas and opinions both verbally and in writing. Listens attentively, responds appropriately, and follows instructions carefully. Asks relevant questions to clarify needs and information.
• Training & Patient Education: Acts as a preceptor, sharing knowledge and fostering learning. Develops individualized education plans for patients and families and evaluates their effectiveness.
• Ethical Practice: Upholds high confidentiality standards in handling sensitive information, including medical records and HIPAA compliance. Demonstrates trustworthiness and ethical behavior in all interactions.
• Why IU Health? As part of Indiana's largest healthcare system, we offer:
• Competitive salary and comprehensive benefits
• Opportunities for professional growth and development
• A collaborative, innovative environment committed to excellence