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Utilization Case Manager Jobs in New Mexico (NOW HIRING)

A24Group

Director of Case Management FT

Las Cruces, NM · On-site

Direct the implementation and coordination of utilization management processes to ensure appropriate level of care and resource utilisation * Oversee case management activities across the patient ...

UNMHSCHS

RN CASE MANAGER

Albuquerque, NM · On-site

Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... N Case Managers have a 1:25-30 patient ratio and support all age groups from newborn to seniors.

Matrix Providers

$52.25 - $55/hr

Integrate CM and utilization management (UM) and integrate nursing case management with social work case management. * Maintain liaison with appropriate community agencies and organizations.

KurzSolutions

RN Case Manager

Santa Fe, NM · On-site

Assess care needs and resource utilization during consultations with healthcare providers. * Review ... * RN Case Manager c onducts follow-ups to confirm referral documentation and ensure patient ...

UNMHSCHS

RN CASE MANAGER

Rio Rancho, NM · On-site

... utilization of resources. Conduct initial and ongoing assessments, initiate disease management ... case management interventions by utilizing established procedures including census review, risk ...

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Showing results 21-40

All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in New Mexico

Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What is the difference between Utilization Case Manager vs Utilization Review Nurse?

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

What are popular job titles related to Utilization Case Manager jobs in New Mexico?

For Utilization Case Manager jobs in New Mexico, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in New Mexico look for?

The top searched job categories for Utilization Case Manager jobs in New Mexico are:

What cities in New Mexico are hiring for Utilization Case Manager jobs?

Cities in New Mexico with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you

Director of Case Management FT

A24Group

Las Cruces, NM • On-site

Full-time

Re-posted 7 days ago

Job description

Director of Case Management

Our Client  |  Las Cruces, NM 88011  |  Full-Time Exempt  |  Senior Leadership

Reports To

Chief Financial Officer

Location

Las Cruces, NM 88011 — on-site required

Salary Range

Confidential — $110,000 to $140,000

Signing Bonus

Negotiable

Visa Support

Not available

Travel

Not required

The Opportunity

Our client, a community hospital in southern New Mexico, is seeking an experienced Director of Case Management to lead the department through the full patient care continuum. This is a senior leadership role with direct accountability for clinical, financial, quality, and HR management across a multidisciplinary team of RNs, Social Workers, and Clerical Support.

The Director of Case Management will drive patient transitions through the continuum of care in a timely and cost-effective manner, ensuring both clinical outcomes and operational efficiency are optimised.

What You Will Do

Department Leadership

  • Provide strategic and operational leadership for the Case Management Department, including programme planning, education, monitoring, and continuous improvement
  • Oversee and supervise a multidisciplinary team of RNs, Social Workers, and Clerical Support staff
  • Manage departmental HR functions including hiring, onboarding, performance management, and staff development
  • Lead department meetings, maintain communication with the CFO and senior leadership, and represent Case Management in hospital-wide initiatives

Clinical & Utilization Management

  • Direct the implementation and coordination of utilization management processes to ensure appropriate level of care and resource utilisation
  • Oversee case management activities across the patient continuum including acute care, transitions, discharge planning, and post-acute follow-up
  • Ensure timely and clinically appropriate patient progression through the hospital, reducing length of stay and avoidable readmissions
  • Collaborate with physicians, nursing, ancillary services, and payers to facilitate effective care transitions
  • Monitor and manage denial prevention and appeals processes in coordination with clinical staff and payers

Financial & Quality Management

  • Monitor departmental performance against financial targets including length of stay, readmission rates, and case mix index
  • Ensure documentation standards support accurate coding, billing, and reimbursement
  • Lead quality improvement initiatives within Case Management, tracking outcomes and implementing evidence-based best practices
  • Maintain regulatory compliance with CMS, Joint Commission, and state requirements pertaining to case management and discharge planning

What We Are Looking For

Required Qualifications ★

  • ★ Current RN licence in New Mexico or valid compact licence
  • ★ Minimum three years of utilization management and case management experience
  • ★ Minimum two years of leadership experience in a healthcare setting

Preferred Qualifications

  • Certification as a Certified Case Manager (CCM) or Accredited Case Manager (ACM) — strongly preferred
  • Certification by the National Association of Healthcare Professionals or InterQual experience — desirable
  • Experience working in an acute care or for-profit hospital environment
  • Strong working knowledge of payer requirements, insurance authorisation, and denial management
  • Proficiency with EMR documentation and utilization management platforms

About Our Client

Our client is a full-service acute care community hospital in Las Cruces, southern New Mexico, serving a regional population of approximately 300,000. The facility is part of a nationally recognised health system and has been recognised for clinical excellence and workplace culture. Further details available upon candidate qualification.

Selection Process

  • Step 1: Resume review by hiring manager
  • Step 2: Video/Teams interview with CFO
  • Step 3: On-site interview with the team (if applicable)