Utilization Review Rn Jobs in New Mexico (NOW HIRING)

Location Address:

1100 Central Ave SE Albuquerque, NM 87106-4930

Compensation Pay Range:

Minimum Offer $36.41 Maximum Offer $62.00

Summary:

Make a difference. Presbyterian Hospital is hiring a RN Case Manager that will provide clinically-based case management to support the delivery of effective and efficient patient care. The role integrates utilization management, care coordination, and transition planning functions. The Case Manager has the overall accountability for a designated case load and plans effectively in order to meet patients needs, manage the length of stay, and promote efficient utilization of resources. In collaboration with the interdisciplinary team, the case manager supports the physician in facilitating patient care with the objective of enhancing the quality of patient outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers.

How you grow, learn and thrive matters here.
Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
Malpractice liability insurance
Loan forgiveness through the New Mexico Higher Education Department
EPIC electronic charting system

Type of Opportunity: PRN FTE: 0.00 Job Exempt: No Work Shift: Days (United States of America)

Responsibilities:

As an RN Case Manager, you will manage a designated caseload, collaborating with an interdisciplinary team to optimize length of stay, coordinate discharge planning, and support safe transitions across the continuum of care. You will partner with physicians, patients, families, payers, and post-acute providers to improve outcomes, enhance patient satisfaction, and reduce barriers to discharge.

PRN- As needed

Work Schedule: Days

Days 8 hour or 10 hourshifts

Presbyterian Hospital - On-Site

• Manage Patient Caseloads Across the Continuum of Care- Conduct comprehensive assessments, identify barriers to discharge, and ensure patients receive the right care at the right time from admission through transition.

• Coordinate Utilization Management and Status Determination- Apply approved clinical criteria to monitor admissions and continued stay, collaborate with providers on medical necessity documentation, and escalate cases as appropriate.

• Lead Discharge Planning and Care Transitions- Develop and coordinate individualized discharge plans, arrange post-acute services, and ensure timely, safe transitions to prevent delays and reduce readmissions.

• Collaborate with Interdisciplinary Teams- Partner with physicians, nursing, social work, and ancillary services through daily rounds, care conferences, and complex case discussions to optimize length of stay and patient outcomes.

• Drive Quality, Communication, and Documentation Excellence- Maintain accurate, timely documentation; communicate effectively with patients, families, and payers; and contribute to performance improvement and professional development initiatives.

Qualifications:

RN IMM Case Management I

• Associates Degree in nursing required.

• *BSN within 5 years of hire date.

• Current State of New Mexico Registered Nurse licensure required.

• 2 years clinical nursing experience in relevant clinical practice area with utilization review or case management experience desirable.

• National Case Management certification preferred

RN IMM Case Management II

• Registered Nurse with Bachelors of Science in nursing (BSN) degree or Registered Nurse with Associates degree in nursing (ADN) plus five years utilization review or case management experience required.

• BSN to be obtained within 5 years of hire date.

• Current State of New Mexico Registered Nurse licensure required.

• 2 years adult bedside experience required.

• National Case Management certification preferred

RN IMM Case Management III

• Bachelors degree in nursing plus 5 years utilization review or case management experience required; or Masters degree in Nursing.

• Current State of New Mexico Registered Nurse licensure required.

• 2 years adult bedside experience required.

• National Case Management certification preferred.

RN IMM Case Management IV

• Masters degree in nursing plus 5 years utilization review or case management experience required; or Bachelors degree in nursing plus 10 years utilization review or case management experience required.

• Current State of New Mexico Registered Nurse licensure required.

• 2 years adult bedside experience required.

• National Case Management certification preferred

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Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.
Learn more about our employee benefits.
About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Compensation Disclaimer
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services