Manager Utilization Management Jobs in Rio Rancho, NM

Matrix Providers is hiring a Registered Nurse - Case Manager to join our team of talented professionals who provide health care services to our Military Service Members and their families in at Kirtland Air Force Base in Albuquerque, NM.

• Employment Status: Full-time
• Compensation: Hourly position, paid bi-weekly. $50.00- 52.25/hr + H&W $4.57/hr
• Schedule: Monday - Friday. Shifts will normally be scheduled for an eight (8) hour period and no more than forty (40) hours per week, between 6:30 a.m. and 5:30 p.m.
• Benefits: Competitive financial package with a comprehensive insurance package including health, dental, vision, and life coverage.
  • Accrued Paid Time Off (PTO)
  • Paid Holidays (Outlined in Handbook)
  • 401(k) Plan

Requirements:

• Degree: Associate's Degree in Nursing.
• Education: Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) or National League for Nursing Accrediting Commission (NLNAC).
• Certification: If the applicant is not already certified in one of the certifications below, the applicant must obtain the American Nurses Credentialing Center Nurse Case Manager (ANCC) certification within six months of hire.
• Experience: Three years of experience in nursing after graduation. Six to twelve months of case management experience. Experience must include/reflect:
  • knowledgeable in medical privacy and confidentiality (Health Insurance Portability and Accountability Act (HIPAA); accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC) and the Joint Commission (TJC); and computer applications/software, email, and internet familiarity are required.
  • skillful and tactful in communicating with people who may be physically or mentally ill, uncooperative, fearful, emotionally distraught, and occasionally dangerous
  • possess organization, problem-solving and communication skills to articulate medical requirements to patients, families/caregivers, medical and non-medical staff in a professional and courteous way
• Licensure: Current, full, active, and unrestricted license to practice as a Registered Nurse.

Job Summary:

• Provide case management, care coordination and discharge/disposition planning for outpatient care settings. Coordinate care with multiple providers across all levels and sites of care. Address psychosocial, as well as nursing and medical needs of patients and their families/caregivers, through participation in multidisciplinary patient care management practice.
• Assessment: Conduct systematic, on-going, thorough collection of patient’s physical, emotional psychological, social, and medical status and information via direct patient contact and other relevant sources.
• Planning: Develop an appropriate patient-specific plan of care to include short- and long- term goals, objectives, and actions.
• Implementation: Guide the patient and family/care giver through the healthcare system, maximizing use of resources.
• Coordination: Ensure coordination of care delivery processes, to include alternate healthcare settings and the home environment, for the purposes of enhancing the patient’s health and wellness, safety, productivity, and quality of life, and for providing the most beneficial, cost-effective health care.
• Evaluation: Monitoring and evaluation may include but is not limited to patient’s adherence and response to the treatment plan.
• Share knowledge and experiences relevant to nursing and case management.
• Participate in all phases of the Case Management Program (CMP) and ensure that the CMP meets established case management (CM) standards of care.
• Provide nursing expertise about the CM process, including assessment, planning, implementation, coordination, and monitoring. Identify opportunities for CM and identify and integrate local CM processes.
• Develop and implement local strategies using inpatient, outpatient, onsite and telephonic CM
• Develop and implement tools to support case management, such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM software, and databases for community resources.
• Integrate CM and utilization management (UM) and integrate nursing case management with social work case management.
• Maintain liaison with appropriate community agencies and organizations.
• Accurately collect and document patient care data.
• Develop treatment plans, including preventive, therapeutic, rehabilitative, psychosocial, and clinical interventions to ensure continuity of care toward optimal wellness.
• Establish mechanisms to ensure proper implementation of the patient treatment plan and follow-up post-discharge in ambulatory and community health care settings.
• Provide appropriate health care instruction to patients and/or caregivers based on identified learning needs.