RN Case Manager-PRN

Registered Nurse (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.

The RN Case Manager is responsible for assessing patient needs, ensuring appropriate levels of care, coordinating transitions of care, and developing effective discharge plans that support positive patient outcomes. This role works closely with physicians, nursing staff, social workers, payers, and community resources to promote efficient utilization of healthcare services while maintaining the highest standards of quality and patient satisfaction.

Key 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.