Clinical Access Case Manager

San Juan Regional Medical Center; United States; On-site; USD 60,000 - 90,000; Full time

Job summary

San Juan Regional Medical Center in the United States is seeking a Clinical Access Case Manager (CACM) to support patient flow and capacity management. You will coordinate with ED, transfer teams, and providers to determine medical necessity and appropriate admission status.

The role emphasizes utilization review, EMTALA compliance, and collaboration with the MRN and admit team to optimize LOS and resource use, while upholding SJRMC values of safety and compassionate care.

Qualifications

• Current RN license in the state of New Mexico.
• Minimum of three years' experience in acute care.
• Assertive and diplomatic communication skills.
• Self-motivated and accountable.
• Team Oriented.
• Preferred: BSN.
• Preferred: Accredited Case Manager Certification.

Responsibilities

• Management of ports of entry.
• Perform and document clinical reviews to determine medical necessity, using InterQual, and physician determination of LOS.
• Collaborate with admitting provider, obtain and enter appropriate patient status orders in the EMR (i.e., inpatient, outpatient, or observation).
• Perform concurrent utilization review as assigned following contractual obligations.
• Denials and Appeals Management.
• Observation Management: Review observation cases every four hours to assess for possible conversion to Inpatient or stability for discharge.
• Maintains accurate transfer and divert log.
• Supports EMTALA compliance.
• Maintain current knowledge of and follow Medicare and Medicaid requirements.
• Proactively identifying, documenting, and escalating problems with over/under utilization of hospital resources.
• Documents avoidable days as appropriate.
• Collaborates effectively with departmental staff to achieve goals and objectives.
• Utilizes internal or external Physician Advisor as needed to resolve level of care discrepancies.
• Each employee is responsible for implementing SJRMC's Service Standards into their daily work: Safety, Courtesy, Effectiveness, and Stewardship.
• Other duties as assigned.

Skills

RN license

Acute care experience

Assertive communication

Self-motivated

Team oriented

Education

Bachelor's Degree (BSN)

Accredited Case Manager Certification

Job description

Creating Life Better Here starts with you. At San Juan Regional Medical Center, we're more than a healthcare provider-we're a values-driven organization dedicated to delivering exceptional care. As a team member, you help fulfill our mission to make life better here for our community.

The Clinical Access Case Manager (CACM) supports efficient patient flow and capacity management through timely placement of patients from all portals of entry including the emergency department, transferring facilities and procedural areas. CACMs provide a coordinated approach with the providers and Managing Resource Nurse (MRN) to determine appropriateness of admission and the appropriate status. Assures robust utilization review and appeals process.

Required Behaviors :

As you go about fulfilling this mission, your work habits and work relationships should embody SJRMC's values. These values are our culture, our identity as an organization. Sacred Trust, Personal Reverence, Thoughtful Anticipation, Team Accountability and Creative Vitality ask more of us than merely completing some list of tasks. Our values ask for a deeper level of commitment, and what is asked of us we freely give because we believe in our mission.

Required Qualifications :

• Current RN license in the state of New Mexico
• Minimum of three (3) years' experience in acute care required
• Assertive and diplomatic communication skills
• Self-motivated and accountable
• Team Oriented

Preferred Qualifications:

• Bachelor's Degree (BSN)
• Case Management experience
• Accredited Case Manager Certification

Duties and Responsibilities:

• Management of ports of entry.
• Perform and document clinical reviews to determine medical necessity, using InterQual, and physician determination of length of stay (LOS).
• Collaborate with admitting provider, obtain and enter appropriate patient status orders in the EMR (i.e., inpatient, outpatient, or observation)
• Perform concurrent utilization review as assigned following contractual obligations
• Denials and Appeals Management
• Observation Management: Review observation cases every four (4) hours to assess for possible conversion to Inpatient or stability for discharge.
• Maintains accurate transfer and divert log
• Supports EMTALA compliance
• Maintain current knowledge of and follow Medicare and Medicaid requirements
• Proactively identifying, documenting, and escalating problems with over/under utilization of hospital resources
• Documents avoidable days as appropriate
• Collaborates effectively with departmental staff to achieve goals and objectives
• Utilizes internal or external Physician Advisor as needed to resolve level of care discrepancies
• Each employee is responsible for implementing SJRMC's Service Standards into their daily work:
• Safety, Courtesy, Effectiveness, and Stewardship
• Other duties as assigned

Physical Demands and Environmental Work Conditions:

Physical:

• Minimum physical effort required
• Intermittent sitting with freedom of movement
• Minimal walking bending, lifting, pulling, and reaching

Mental:

• Fast paced environment, numerous interruptions, numerous phone calls
• Frequent periods of concentration with attention to details with frequent opportunity for diversification of tasks
• Ability to shift tasks to adjust to patient needs in a timely manner
• Work performed in a modern, well-equipped environment
• Interfaces with fellow employees, patients, and guests of hospital daily
• Able to use various office equipment, including expertise in computer programs in performance of routine duties.