PRC Case Management Nurse - Coordinating Care & Referrals

Indian Health Service; Albuquerque (NM); On-site; USD 85,000 - 105,000; Full time

Job summary

Indian Health Service in Albuquerque seeks a PRC Case Management Nurse to coordinate referrals, assess complex needs, develop care plans, and monitor services within a federal Native healthcare program.

You will work with multidisciplinary teams, patients and families to ensure timely access to Purchased/Referred Care and related resources, and maintain accurate records in a fast-paced environment.

Qualifications

• Registered Nurse with active/state license required.
• Experience coordinating patient care, referrals, and transitions in a healthcare setting.
• Knowledge of Purchased/Referred Care (PRC) requirements and community resources.

Responsibilities

• Review and prioritize patient referrals and coordinate care with IHS providers, outside healthcare facilities, and other programs to help patients receive appropriate and timely services.
• Provide case management for patients with complex healthcare needs, including assessing needs, developing care plans, monitoring services, addressing barriers to care, and coordinating follow-up.
• Coordinate referrals and transitions of care by working with healthcare teams, case managers, social workers, patients, families, and community partners.
• Assist patients with accessing needed services by obtaining prior authorizations, supporting insurance appeals, identifying available resources, and applying Purchased/Referred Care (PRC) requirements.
• Maintain accurate patient and referral information, track the status of referrals, participate in care team meetings, and identify ways to improve referral and case management processes.

Skills

Nursing

Case management

Referral coordination

Communication

Education

Bachelor of Science in Nursing

Job description

Indian Health Service in Albuquerque seeks a PRC Case Management Nurse to coordinate referrals, assess complex needs, develop care plans, and monitor services within a federal Native healthcare program.

You will work with multidisciplinary teams, patients and families to ensure timely access to Purchased/Referred Care and related resources, and maintain accurate records in a fast-paced environment.