Nurse Case Manager: Care Coordination & Utilization Review

Dilkon Medical Center | Winslow Indian Health Care; Winslow (AZ); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Travel opportunities

Job summary

Winslow Indian Health Care Center is seeking a Registered Nurse with expertise in utilization review and case management to coordinate referrals and transitions of care for PRC patients. You will review admissions, determine medical necessity, facilitate preauthorizations, discharge planning, and collaborate with interdisciplinary teams while upholding HIPAA and tribal health program standards.

Travel within the service area may be required; bilingual Navajo-English is preferred.

Qualifications

• RN license in a U.S. state; CCMC preferred.
• Experience in utilization management and case management.
• Knowledge of tribal health programs and payer regulations.

Responsibilities

• Manage utilization review and case management for referred care.
• Coordinate transitions in care and track referrals.
• Obtain preauthorization when required.
• Conduct concurrent and retrospective reviews for admission and care.
• Assess medical necessity and level of care using CMS criteria.
• Coordinate discharge planning and post-discharge care.
• Advocate for patients and families; collaborate with teams.
• Provide staff training to improve communication.
• Travel within service area as needed.

Skills

Utilization review

Case management

Nursing licensure

CMS criteria knowledge

Discharge planning

Interdisciplinary teamwork

HIPAA compliance

Navajo language

Communication skills

EHR systems

RPMS proficiency

Team leadership

Education

Bachelor's degree in Nursing

CCMC certification (preferred)

Associates degree with nursing experience

Tools

RPMS

EHR platforms

Cerner

Epic

Novitasphere

AHCCCS portals

Microsoft Excel

Job description

Winslow Indian Health Care Center is seeking a Registered Nurse with expertise in utilization review and case management to coordinate referrals and transitions of care for PRC patients. You will review admissions, determine medical necessity, facilitate preauthorizations, discharge planning, and collaborate with interdisciplinary teams while upholding HIPAA and tribal health program standards.

Travel within the service area may be required; bilingual Navajo-English is preferred.