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.

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Position Overview:

The RN-Case Manager for Primary Care 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 assists with a smooth transition from hospital discharge to care at home and facilitates patient education and safety.

Position Schedule: Full-time, day shift, Monday-Friday - Remote

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Key Responsibilities:

• Collaborate local Primary Care offices to assist with patient appointment scheduling.

• 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.

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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.

- Strong clinical background with excellent assessment and communication skills.

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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.

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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

To learn more about our benefits, visit: (https://careers.iuhealth.org/pages/benefits-designed-for-you)

• Indiana University Health has nearly 40,000 team members, including more than 3,600 physicians and 1,200 advanced practice providers, and we’re home to the largest nursing network in Indiana with more than 9,000 nursing team members at over 800 sites of care.
• IU Health is ranked No. 1 in Indiana by U.S. News & World Report, Riley Children's Health is ranked among the top children's hospitals in the country by U.S. News & World Report.
• A unique partnership with the Indiana University School of Medicine – one of the nation’s largest medical schools – gives patients access to groundbreaking research and innovative treatments, and it offers team members access to the latest science and the very best training – advancing healthcare for all.
• With 15 hospitals, including seven with Magnet designation and eight with Pathways to Excellence designation, our team members are leading the way through excellence.
• At Indiana University Health, your personal and professional growth is a top priority. You will have access to many diverse opportunities to learn and develop in meaningful ways that matter most to you, such as advanced clinical training, leadership development, promotion opportunities and cross training development.
• Indiana University Health is invested in the lives of Hoosiers, leading the transformation of healthcare to make Indiana one of the nation’s healthiest states.