Nurse Case Manager: Multi-Facility Care Coordination

Tohono O'odham Nation; San Simon (AZ); On-site; USD 70,000 - 90,000; Full time

Job summary

Tohono O'odham Nation Health Care is seeking an RN with utilization review experience to assess referrals, coordinate discharge planning, and identify patient resources. The role requires collaboration with physicians and hospital staff across TONHC facilities.

Candidates should have an Associate's Degree in Nursing, an active US RN license, and at least two years of clinical nursing experience. CPR/AED certification is required; background checks may be conducted.

Qualifications

• Associate's Degree in Nursing is required.
• Current US RN license with no restrictions.
• Two years of nursing experience in a clinical setting.
• Bachelor's degree in Nursing preferred.
• CPR and AED certification required.
• Background checks and driving record review may be required.

Responsibilities

• Review referrals for specialty/hospital services under Purchased Referred Care criteria.
• Identify alternate resources for patients (Medicare/Medicaid/private insurance).
• Approve or deny services and document rationale for providers and patients.
• Review medical records to support admissions and continued stays per Interqual criteria.
• Refer patients to AHCCCS, ALTC, DDD, CRS and coordinate COB/TPL when applicable.
• Act as liaison between physicians and hospital staff; represent TONHC externally.
• Coordinate discharge plans and weekly discharge planning meetings.
• Develop and distribute reports to track utilization trends.
• Track high-cost cases and CHEF requests; prepare reports for committees.
• Perform special projects and other duties as assigned.

Skills

HIPAA compliance

Utilization review

Discharge planning

Team collaboration

Policy development

Communication skills

Education

Associate's Degree in Nursing

Bachelor's degree preferred

Job description

Tohono O'odham Nation Health Care is seeking an RN with utilization review experience to assess referrals, coordinate discharge planning, and identify patient resources. The role requires collaboration with physicians and hospital staff across TONHC facilities.

Candidates should have an Associate's Degree in Nursing, an active US RN license, and at least two years of clinical nursing experience. CPR/AED certification is required; background checks may be conducted.