Nurse Case Manager: Care Coordination & Referrals

Tohono O'odham Nation Healthcare; San Simon (AZ); On-site; USD 75,000 - 95,000; Full time

Job summary

Tohono O'odham Nation Health Care is seeking a nurse to provide comprehensive clinical care within a clinic/ambulatory setting and to assist physicians and patients. The role emphasizes case management, review of referrals, discharge planning, and coordination of care across TONHC facilities including Sells Hospital and multiple health centers.

The incumbent will work under the Purchased Referred Care Division, using Interqual criteria and HIPAA guidelines to support admissions and continuity of

Qualifications

• Bachelor's degree in Nursing preferred.
• Current and unrestricted nursing license in the United States.
• Two years of nursing experience in a clinical setting.

Responsibilities

• Review referrals for specialty and hospital-based services under PRC criteria.
• Identify alternate resources for patients (Medicare, Medicaid, private insurance).
• Approve or deny services for providers and patients.
• Review medical records to support admission certification and continued stays.
• Coordinate discharge plans with hospital/skilled nursing facility staff.
• Track utilization trends and high-cost cases; prepare CHEF requests.
• Perform special projects and other duties as assigned.

Skills

Nursing knowledge

Interqual utilization review

Discharge planning

Communication skills

Coordination of benefits

Policy development

Education

Associate's Degree in Nursing

Bachelor's degree in Nursing preferred

Job description

Tohono O'odham Nation Health Care is seeking a nurse to provide comprehensive clinical care within a clinic/ambulatory setting and to assist physicians and patients. The role emphasizes case management, review of referrals, discharge planning, and coordination of care across TONHC facilities including Sells Hospital and multiple health centers.

The incumbent will work under the Purchased Referred Care Division, using Interqual criteria and HIPAA guidelines to support admissions and continuity of