Nurse Case Manager

University of New Mexico - Hospitals; Bernalillo (NM); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Sign-On Bonus Available

Relocation Assistance Available

Job summary

University of New Mexico Hospital is hiring an RN Case Manager for the Care Management Department in Albuquerque. Inpatient and outpatient care management roles include coordinating discharge planning, transitions of care, and care coordination across age groups with a 1:25-30 ratio.

Positions may require weekdays 8-4:30 and weekend/holiday coverage; on-call responsibilities exist for weekends. Merge with SRMC Care Management as needed.

Qualifications

• RN nursing degree from an accredited program.
• 1 year directly related RN experience preferred.
• Current RN license in NM or eligible by reciprocal agreement.
• CPR/BLS certification or obtain within 30 days of hire.

Responsibilities

• Coordinate inpatient care and discharge planning across all ages.
• Support outpatient care plans and referrals to DME, home health, hospice, etc.
• Collaborate with primary/specialty care teams in clinic settings.
• Manage utilization management tasks and ensure medical necessity and proper billing.
• Attend daily multidisciplinary rounds and support care transitions on assigned units.

Education

RN nursing degree

Tools

Powerchart Cerner/Oracle EMR

Microsoft Excel

Microsoft Word

Electronic faxing/scanning

Job description

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.

• Primary work location is an onsite position managing patients in the Emergency room.
• Positions are a 10 hour shift and work a set schedule that includes weekends and Holiday rotation.

Inpatient Care Management- SRMC Campus:

Supports patient’s inpatient stay through care coordination, dischargeplanningand proactively discharging patient safely to the next level of care when medically ready. RN Case Managers areassigned to units andhave a 1:25-30 patient ratio andsupport forall age groups. RN CM attends daily multidisciplinary rounds and worksalongsideSocial Work case manager, case management assistants, providers, therapist, and pharmacistdaily. This work is done primarily in personon their assigned unit/s.

• Most positions will be Monday- Friday from 8-430pm.
• Weekend and PRN availability
• There is required on-call forevenings and weekends (approximately 10 days/year)
• Holiday coverage (approximately2 Holidays/year)

MINIMUM QUALIFICATIONS

EDUCATION:Nursing program (nationally accredited) graduateEXPERIENCE:1 year directly related experienceCERTIFICATIONS:RN MATRIX - Complete and maintain unit/clinic based required certifications and competencies as listed in the department expectations/and or the unit/clinic education matrixLICENSES/CERTIFICATIONS:CPR Certification for Healthcare/BLS Providers or for Professional Rescuers or must obtain within 30 calendar days of date of positionLicensed Registered Nurse (RN) in State of New Mexico or as allowed by reciprocal agreement by State of New MexicoCAP III - Clinical Advancement Program Level III requirements satisfiedTESTING REQUIREMENTS:Tuberculosis testing is completed upon hire and additionally as required

PREFERRED QUALIFICATIONS

PREFERRED EDUCATION:Bachelor's Degree of Science in NursingPREFERRED EXPERIENCE:Bilingual English/SpanishBilingual English/Keres, Tewa, Tiwa, Towa, Zuni, or Navajo

Sign-On Bonus Available

Relocation Assistance Available

Department: Registered Nurse