Registered Nurse (RN) - Case Management
TLC
Case Manager
Schedule: Mon–Fri, 08:00–17:00
Requirements:
- Minimum of 1 year of experience
- BLS certification required
- Charting experience required (system: Any)
Roles & Responsibilities:
- Coordinate patient care and facilitate discharge planning.
- Conduct utilization reviews in accordance with InterQual and Milliman guidelines.
- Ensure compliance with CMS, DRG, ICD-10, and CPT coding/billing standards.
- Monitor quality metrics, including HEDIS, NCQA, and core measures set by The Joint Commission.
- Adhere to regulatory and compliance standards, including HIPAA and OSHA.
- Manage workers' compensation processes as needed.
Compliance / Notes:
- Pending NM/Compact license accepted but must be obtained prior to start.
- All requested time off (RTO) must be listed at time of submittal; a maximum of 4 days RTO can be auto-approved.
- Completion of orientation modules required onsite.
- Orientation modules for RNs: average 4–6 hours; for Allied staff: average 2–3 hours.
Client Details:
City: Albuquerque
State: NM
Vacancy posted 10 hours ago
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