Utilization Management Nurse Jobs in Indiana (NOW HIRING)

You belong at Union!

The RN House Care Manager plays a key role on the Case Management team!

Join us as we provide compassionate service and high-quality care to the Wabash Valley Communities. We are committed to helping you find a role that recognizes your interests, expertise, and talent and helping you achieve your long-term career goals and aspirations. At Union, you’ll experience an inclusive environment in which you are empowered to be your best self every day.

In addition to competitive pay, Union co-workers enjoy:

• Part-time and Full-time schedules
• Comprehensive Benefits
• Paid Time Off starting day one.
• Tuition reimbursement up to $5,250 each year.
• Career Paths 
• Success Sharing
• 403b Retirement Employer Match.
• Much More!

Be part of an organization that is dedicated to your work-life balance, career, growth, and development. Union Health, U Matter and U Belong.

How can we help? Call us at 812-238-7827 or email us at recruiting@union.health

RN House Care Manager – IP
 

1. Assesses and conducts reviews for medical necessity, appropriateness of admission/continued stay/level of care, and post-discharge reviews. 
2. Reviews medical records and assesses patient to effectively communicate with physicians. 
3. Intervenes when determinations are not in alignment. 
4. Collaborates with UR Committee Physicians and makes appropriate referrals.
5. Supports the prevention of payer denials. 
6. Examines clinical situation to make appropriate decisions to support medical necessity of facility settings using established screening criteria to ensure all required documentation is present.
7. Identifies potential unnecessary services and care delivery settings and, if appropriate, recommends alternatives to the care team. 
8. Works in partnership with the Care Manager and physician to incorporate an interdisciplinary approach to support continuity of care and identified needs, utilization management, transfer coordination, and discharge planning. 
9. Issue Medicare Notices as applicable (IM Message, MOON, Code 44 Education, etc.)
10. Maintains clinical knowledge specific to the group of patients being managed. 
11. Maintains knowledge of Medicare guidelines and policies. 
12. Maintains knowledge of value based programs specific to Medicare. 
13. Assesses the patient and family for continuing care needs, including education and financial needs.
14. Reviews medical records and interviews patient and/or family as appropriate, assesses and investigates patient’s needs and acts accordingly. 
15. Communicates and collaborates with patient, family, social worker and/or resource coordinator, and entire health care team to develop and implement a discharge plan appropriate for the patient’s needs. 
16. Helps to determine and coordinate plans of care, including physical, financial, and psychosocial needs to help improve quality outcomes and decrease costs.  
17. Demonstrates understanding of the physical and emotional needs of patient and/or family. 
18. Uses knowledge of usual length of stay to initiate a plan for discharge. 
19. Supports the process of patient choice in establishing a discharge plan. 
20. Reviews medical records and interviews patient and/or family as appropriate, assesses and investigates patient’s needs and acts accordingly. 
21. Identifies and addresses actual/potential barriers to discharge. 
22. Completes tasks as necessary to meet plan of care goals; tasks may include, but are not limited to:
23. Assistance with arrangement of transportation
24. Working with patient on financial assistance for medicine
25. Making referrals to community resources (DME providers, home health care, skilled nursing facilities, mental health providers, etc.)
26. Collaborates with agencies such as, but are not limited to: APS, CPS, etc.
27. Assistance with advanced directives as applicable.
28. Coordinates with physicians and nursing to confer if interventions need to be modified or adjusted.
29. Effectively manages length of stay by:
30. Using clinical knowledge to identify a target discharge date.

Education, Training & Experience

1. Must have graduated from an accredited nursing program – BSN preferred
2. Must have active IN RN license 
3. Case Management Experience Preferred.
4. Hospital Experience
5. Must have active BLS certification

Please note that the salary information provided on the career site for this position opening may not necessarily reflect the accurate compensation associated with the role.

We encourage candidates to inquire further and engage in direct communication with Union Health for comprehensive salary details.
 

As an EOE/AA employer, Union Hospital, Inc. will not discriminate in its employment practices due to an applicant's age, race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran or disability status.