Full-Time RN Case Manager

About the Role

This position supports the Care Management Department in both inpatient and outpatient services, focusing on utilization management and care coordination efforts.

Responsibilities

• Provide care coordination, discharge planning, and transition of care for patients of all ages.
• Collaborate with multidisciplinary teams during inpatient rounds and outpatient clinics.
• Support outpatient referrals for DME, home healthcare, and hospice.
• Review medical necessity and billing accuracy; assist with appeals and denials.
• Ensure safe discharge and minimize readmissions.
• Work primarily in remote or clinic settings with some in-person duties.

Key Duties

• Support inpatient and outpatient care coordination.
• Participate in multidisciplinary rounds and collaborate with providers.
• Manage referrals and transition of care processes.
• Conduct utilization reviews and assist with billing and insurance interactions.
• Work primarily in person, in clinic, or remotely post-orientation.
• Maintain required certifications and compliance.

Qualifications & Skills

• Graduate of an accredited nursing program.
• Active RN license in New Mexico.
• CPR/BLS certification.
• At least 1 year of relevant experience.
• Must meet clinical competencies and pass TB testing.

Preferred qualifications include a Bachelor's in Nursing and bilingual abilities (English/Spanish or other languages).