Case Manager-RN

Employment Type: Full time Shift: Day Shift Description: Full Time Days 8-hour shifts Position Summary: -The Utilization Review (UR) Case Manager – Post-Acute Prior Authorization role performs Utilization Review activities and serves as the central coordinator for post‑acute prior authorizations (PAs) for skilled nursing, swing bed, CAH swing, acute rehab, LTACH, and other post‑acute levels of care. -This role drives timely authorization determinations, reduces authorization‑related delays, supports throughput goals, decreases avoidable inpatient days, and helps ensure efficient discharge planning. Responsibilities include PA submission and follow‑up, denial‑prevention support, external notifications, data extraction from the chart, Epic work queue tasks, supporting second IMM processes as needed, coordination with payers and post‑acute facilities, and assists with other appropriate administrative support for the acute care management team. Essential Functions: 1) Post‑Acute Prior Authorization Management (Primary Function) Centralizes, submits, monitors, and follows up on post‑acute prior authorizations using payer portals, phone calls, and clinical documentation workflows. Ensures complete and accurate clinical packets; escalates delays when authorization timelines exceed expectations. Documents all PA activity in Epic and maintain standardized PA workflows for consistency and efficiency. Communicates PA status and clinical needs to post‑acute facilities, payers, case managers, social workers, and fellow UR RNs. Provides external notification of discharges and post‑acute transfers. Supports implementation and evaluation of the centralized PA workflow, including establishing a regular cadence for outcome monitoring. 2) Utilization Review & Denial Prevention Support Extracts meaningful data from the medical record to support UR RN clinical reviews. Identifies potential concurrent denials and routes information to UR RNs promptly. *For full list of responsibilities please request job description* Minimum Qualifications: Education & Licensure Must be one of the following: Registered Nurse (RN) with an active, unrestricted license Bachelor of Science in Nursing (BSN) strongly preferred Experience Minimum five years of direct RN practice required. Prior experience interacting with insurance companies, payers, or care partners—or a strong interest in learning how to navigate authorization processes and advocate for timely, appropriate patient discharges—is preferred. Certifications Basic Life Support (BLS) within 60 days of hire; must maintain certification. Mandatory Reporter – Child & Dependent Adult Abuse within 6 months of hire; renewal per policy. Knowledge, Skills & Abilities Strong organizational and time‑management skills; detail‑oriented. Proficient in email, internet navigation, payer portals, and Microsoft Excel and Word. Ability to multitask and work independently while collaborating with multidisciplinary teams. Strong customer‑service skills aligned with MercyOne mission and values. We care about your well-being, both physical and mental, which is why our benefit package includes: Wellness programs Education reimbursement Personalized health insurance plans (including dental and vision) PTO Long- and short-term leave Retirement planning Life insurance coverage Ministry/Facility Information: Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. MercyOne North Iowa Medical Center provides expert health care to 15 counties. MercyOne North Iowa Medical Center is a 342 bed, regional referral teaching hospital in Mason City, Iowa. MercyOne New Hampton Medical Center is an 11 bed, rural access hospital in New Hampton, Iowa. Our service area spans 15 counties across northern Iowa and southern Minnesota. We serve a population over 260,000. With more than 3,000 colleagues and a medical staff of almost 500 physicians and allied health professionals, MercyOne North Iowa Medical Center is the largest employer in the region. MercyOne Medical Group – North Iowa is part of Iowa’s largest multispecialty clinic systems. In north Iowa, our clinics are made up of more than 25 primary care, pediatric, internal medicine and specialty clinics. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.