Interqual Training Operation Jobs in Indiana (NOW HIRING)

PRN/Supplemental RN Case Manager - IU White Memorial & IU Frankfort Hospitals

The PRN/Supplemental RN Case Manager supports IU White Memorial and IU Frankfort hospitals by providing flexible, as-needed case management services to ensure seamless patient care coordination across the care continuum. This role involves working collaboratively with the multidisciplinary team to plan, coordinate, and facilitate patient care from pre-admission through post-discharge, ensuring optimal patient outcomes and appropriate utilization of resources.

Key Responsibilities:

• Support the care coordination process by assessing patient needs and developing individualized care plans.
• Ensure patients are assigned the appropriate level of care, receive necessary services, and transition smoothly to post-discharge care settings.
• Perform accurate, timely, and effective discharge planning in collaboration with clinical teams.
• Communicate with third-party payers to verify coverage and authorization requirements.
• Educate patients and families regarding care plans, medications, and health management.
• Administer education and prevention programs to promote health and wellness.
• Support hospital compliance with regulatory and payer guidelines, including Medicare, Medicaid, and commercial insurance.
• Assist with documentation and software systems such as Cerner, MCCM, SMS, and Windows applications.

Qualifications:

• Associate's Degree in Nursing required. BSN preferred.
• Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license.
• Certification in Case Management preferred.
• Knowledge of InterQual Acute Level of Care Criteria and Federal guidelines outlining coverage of inpatient and outpatient hospital services, including observation is preferred.
• Knowledge of Medicare/Medicaid, insurance and regulatory guidelines is preferred.
• Ability to comprehend third party contractual arrangements is preferred.
• Understanding of the third party denial and appeal process is preferred.
• Requires knowledge of various software applications including Windows; Cerner; MCCM; and SMS.
• 3-5 years of experience required.
• Requires strong clinical background in acute care.

This position offers flexibility and an opportunity to support our team as needed, contributing to high-quality patient care and operational efficiency across our hospital sites. Apply today, we would love to hear from 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.