What are the responsibilities and job description for the Care Manager position at UnityPoint Health?
Overview
Responsibilities
Qualifications
Join our dynamic team at UnityPoint Health as a Managed Care RN - Case Manager!
Location: Remote or Hybrid (Based on Experience)
Hours: Full-Time, Monday-Friday, 8:00 AM - 5:00 PM
What You'll Do:
- Coordinate Care: Collaborate with interdisciplinary teams to ensure patients receive the right care at the right time.
- Manage Utilization: Handle payment authorizations, clinical coordination, and discharge planning.
- Support Patients: Monitor plans of care, address needs, and facilitate community resources.
Why UnityPoint Health?
- Commitment to our Team - For the third consecutive year, we're proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare for our commitment to our team members.
- Culture - At UnityPoint Health, you matter. Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
- Benefits - Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you're in.
- Diversity, Equity and Inclusion Commitment - We're committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
- Development - We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.
- Community Involvement - Be an essential part of our core purpose-to improve the health of the people and communities we serve.
Visit https://dayinthelife.unitypoint.org/ to hear more from our team members about why UnityPoint Health is a great place to work.
Responsibilities
- Performs utilization and case management reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources and payment approval.
- Requests reviews with physician advisors, and/or Executive Health Resources (EHR), as appropriate, if admission or continued stay criteria are not met, assuring appropriate and timely level of care status.
- Conducts payment authorizations and coordinated payment denials while meeting timeliness guidelines.
- Ensures case coordination with client's health care providers.
- Provides utilization management and case management to designated enrollees. Assuring that all enrollees receive clinically sound triage/referral and ongoing care management services for medical needs.
Qualifications
Education:
- Registered Nurse
- CCM (Certified Case Manager)
Experience:
- 5 years of nursing experience
- Insurance experience on the company side is required.
License(s)/Certification(s):
- Compact Nursing License / or licensed behavioral health clinician. Required Illinois and Iowa licenses within first 90 days of hire
Knowledge/Skills/Abilities:
- Professional Communication - written & verbal
- Customer/patient focused
- Self-motivated
- Managing priorities/deadlines
- Flexibility to adapt to changing priorities or needs
- Planning and organizing skills
- MS Office proficiency (Outlook, Word)
- Ability to give work direction to non-clinical staff
#RYCJessi
- Area of Interest: Nursing;
- FTE/Hours per pay period: 1.0;
- Department: Prec Carve Out;
- Shift: 8:00am to 5:00pm Monday through Friday;
- Job ID: 158321;
