Overview

• Collaborate with the multidisciplinary team throughout the patient's care continuum, from pre-admission to post-discharge settings.
• Ensure that patients receive the appropriate level of care and services tailored to their individual needs.
• Develop and implement effective discharge planning, ensuring timely and accurate transitions for patients.
• Work closely with third-party payers to verify coverage and facilitate access to necessary services.
• Administer education and prevention programs to empower patients in managing their health and care.
• Maintain knowledge of InterQual Acute Level of Care Criteria and federal guidelines that govern coverage for inpatient and outpatient hospital services, including observation status.
• Stay informed about Medicare/Medicaid regulations, insurance processes, and relevant regulatory guidelines.
• Navigate third-party denial and appeal processes effectively to support patient care and coverage needs.
• Utilize various software applications (including Windows, Cerner, MCCM, and SMS) to document and manage patient care effectively.

• Associate's Degree in Nursing required; New ASN RNs hired after January 1, 2013, must complete their BSN within five years from the date of hire.
• Active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license required.
• Certification in Case Management is preferred.
• Knowledge of InterQual Acute Level of Care Criteria and federal guidelines governing hospital services preferred.
• Understanding of Medicare/Medicaid, insurance regulations, and third-party contractual arrangements is preferred.
• Familiarity with the third-party denial and appeal processes preferred.
• Strong clinical background in acute care required, with 3-5 years of relevant experience.
• Proficiency in various software applications, including Windows, Cerner, MCCM, and SMS.

• 401(K) retirement savings with employer match
• Tuition reimbursement
• Student loan forgiveness - Government program that may allow qualifying participants to have the remainder of their student loan balance forgiven (after a set amount of time and specific qualifications have been met).
• Employee Assistance Program – Counseling at no cost to you
• Healthy Results - Participation in our team member wellness programs award points that contribute toward a biweekly financial incentive in your paycheck! The more you participate, the more you earn!

We are an equal opportunity employer and value diversity and inclusion at IU Health. IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.