About this opportunity
Aya Healthcare lists this Case Manager opportunity in albuquerque, New Mexico. Review the employer’s description below for duties, qualifications and application requirements.
Job description
RN Case Manager
RN Case Manager Care Management Department - University of New Mexico Hospital Albuquerque
Inpatient Care Management: Supports patients inpatient stay through care coordination, discharge planning, and proactively discharging patients 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, therapists, and pharmacists on a daily basis. This work is done primarily in person.
Most positions will be Monday-Friday from 8-4:30pm. Weekend and PRN availability includes required on-call for weekends (10 days/year) and 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 the 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 . Position schedule primarily Monday-Friday from 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. Clinics are closed on major holidays.
Utilization Management: Supports the medical necessity and 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 patients inpatient stay through care coordination, discharge planning, and proactively discharging patients 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 8-4:30pm. Weekend and PRN availability includes required on-call for evenings and weekends (approximately 10 days/year) and 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
Worksite address
albuquerque, NM, 87101, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.