Utilization Management Case Manager Rn Jobs in New Mexico

RN CASE MANAGER - CARE MANAGEMENT DEPARTMENT - University of New Mexico Hospital - Albuquerque
*Inpatient
*Outpatient
*Utilization Management
*SRMC Care Management
*Full Time
*Part Time
Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials
Compensation Disclaimer
Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations.
Care Management Department Descriptions:
Your application may be considered for any of the below programs. We will work with you to find the best fit.
Inpatient Care Management: Supports patient's inpatient stay through care coordination, discharge planning and proactively discharging patient safely to the next level of care when medically ready. RN Case Managers have a 1:25-30 patient ratio and support all age groups from newborn to seniors. From birth to end of life needs. RN CM attend daily multidisciplinary rounds and work alongside providers, therapist, pharmacist on a daily basis. This work is done primarily in person.
• Most positions will be Monday- Friday from 8-430pm.
• Weekend and PRN availability
• There is required on-call for weekends (10 days/year)
• Holiday coverage (2 Holidays/year)
Outpatient Care Management: Supports patient needs in the outpatient clinic setting, that encompasses care plan facilitation, transition of care coordination between an acute care setting to the home. RN Case Manager (RNCM) will assist with referrals in the areas of Durable Medical Equipment (DME) support, Home Healthcare, Hospice, and any other care coordination needs that helps patients continue to stay at home and reduce readmission to the hospital.
RN CM work collaboratively with primary and specialty care providers within clinic setting. Ratios vary depending on clinic site but can vary depending on whether it is a specialty clinic versus a primary care clinic.
• Primarily working on computer and phone, navigating multiple software systems/programs to send and receive referrals for patients.

• Microsoft excel and word
• Powerchart - Cerner/Oracle electronic medical record
• electronic faxing/scanning system.

• Clinic hours are normally 0800-1700.
• Position schedule primarily Monday- Friday from 0800-1630, with some flexibility.
• Primarily work in clinic setting with consideration for one work from home day after 6 months of employment and successful completion of competency requirements.
• No weekends or on-call work requirement.
• Clinics are closed on major holidays.
Utilization Management:
Supports the medical necessity appropriateness for all patients receiving treatment/services. This is supported by a chart review for the level of care and correcting billing aspects of care for our patients while they are hospitalized. They provide provider support, appeals and denials and work directly with insurance payors to recuperate payment for patient care. There is limited patient interaction.
• Primarily a remote work from home position once applicant has successfully completed the onsite orientation phase.
• Most positions are Monday-Friday 7-3:30, with additional weekend positions and prn availability. Scheduled Holiday rotations.
• Staff can be requested to attend in-person meetings, trainings or come into the work environment if any remote work issues arise.
Inpatient Care Management- SRMC Campus: Supports patient's inpatient stay through care coordination, discharge planning and proactively discharging patient safely to the next level of care when medically ready. RN Case Managers are assigned to units and have a 1:25-30 patient ratio and support for all age groups. RN CM attends daily multidisciplinary rounds and works alongside Social Work case manager, case management assistants, providers, therapist, and pharmacist daily. This work is done primarily in person on their assigned unit/s.
• Most positions will be Monday- Friday from 8-430pm.
• Weekend and PRN availability
• There is required on-call for evenings and weekends (approximately 10 days/year)
• Holiday coverage (approximately 2 Holidays/year)
MINIMUM QUALIFICATIONS
EDUCATION:
Nursing program (nationally accredited) graduate
EXPERIENCE:
1 year directly related experience
CERTIFICATIONS:
RN MATRIX - Complete and maintain unit/clinic based required certifications and competencies as listed in the department expectations/and or the unit/clinic education matrix
LICENSES/CERTIFICATIONS:
CPR Certification for Healthcare/BLS Providers or for Professional Rescuers or must obtain within 30 calendar days of date of position
Licensed Registered Nurse (RN) in State of New Mexico or as allowed by reciprocal agreement by State of New Mexico
CAP III - Clinical Advancement Program Level III requirements satisfied
TESTING REQUIREMENTS:
Tuberculosis testing is completed upon hire and additionally as required
PREFERRED QUALIFICATIONS
PREFERRED EDUCATION:
Bachelor's Degree of Science in Nursing
PREFERRED EXPERIENCE:
Bilingual English/Spanish
Bilingual English/Keres, Tewa, Tiwa, Towa, Zuni, or Navajo
Sign-On Bonus Available
Relocation Assistance Available