Job Description

• Remote: Yes
• Area of Interest: Nursing
• Salary Range: $35.18-$52.78/hr*
• FTE/Hours per pay period: 1.0
• Department: Prec Carve Out
• Shift: 8:00am to 5:00pm Monday through Friday
• Job ID: 158321

UnityPoint Health Information
Why UnityPoint Health? 
Commitment to our Team – We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row 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 an 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.    
• Caring is what we do, and it starts with our team members: expect paid time off, parental leave, 401K matching and an employee recognition program as we support you both personally and professionally.  
• You can only give your best when you feel your best, and we help you live well with dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members to give you peace of mind.   
• We strive to make things easier and more personal in health care to set us apart from the rest, and you can experience that commitment through early access to earned wages with Daily Pay, a tuition reimbursement program designed to help you further your career and adoption assistance to help you grow your family in the way that works for you.  

 
Diversity, Equity and Inclusion Commitment – At UnityPoint Health, we honor the ways people are unique and embrace what brings us together. Our collective goal is to champion a culture of belonging where everyone feels valued and respected.  
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.   
Hear more from our team members about why UnityPoint Health is a great place to work at
Overview
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.

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
• Specific offers are determined by various factors, such as experience, skills, internal equity, and other business needs. The salary range listed does not include other forms of compensation which may include bonuses/incentive, differential pay, or other forms of compensation or benefits that may be applicable to this role. 

#RYCJessi

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