Nurse Case Manager

RN CASE MANAGER - CARE MANAGEMENT DEPARTMENT - University of New Mexico Hospital - Albuquerque *Inpatient *Outpatient *Utilization Management *SRMC Care Management *Full Time*Part Time Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Care Management Department Descriptions: Your application may be considered for any of the below programs. We will work with you to find the best fit. Inpatient Care Management: Supports patient's inpatient stay through care coordination, discharge planning and proactively discharging patient safely to the next level of care when medically ready. RN Case Managers have a 1:25-30 patient ratio and support all age groups from newborn to seniors. From birth to end of life needs. RN CM attend daily multidisciplinary rounds and work alongside providers, therapist, pharmacist on a daily basis. This work is done primarily in person. · Most positions will be Monday- Friday from 8-430pm. · Weekend and PRN availability · There is required on-call for weekends (10 daysyear) · Holiday coverage (2 Holidaysyear) Outpatient Care Management:Supports patient needs in the outpatient clinic setting, that encompasses care plan facilitation, transition of care coordination between an acute care setting to the home. RN Case Manager (RNCM) will assist with referrals in the areas of Durable Medical Equipment (DME) support, Home Healthcare, Hospice, and any other care coordination needs that helps patients continue to stay at home and reduce readmission to the hospital. RN CM work collaboratively with primary and specialty care providers within clinic setting. Ratios vary depending on clinic site but can vary depending on whether it is a specialty clinic versus a primary care clinic.· Primarily working on computer and phone,navigating multiple software systemsprograms to send and receive referrals for patients. Microsoft excel and wordPowerchart - CernerOracle electronic medical recordelectronic faxingscanning system.· Clinic hours are normally 0800-1700. · Position schedule primarily Monday- Friday from 0800-1630, with some flexibility. · Primarily work in clinic setting with consideration for one work from home day after 6 months of employment and successful completion of competency requirements. · No weekends or on-call work requirement. · Clinics are closed on major holidays. Utilization Management:Supports the medical necessity appropriateness for all patients receiving treatmentservices. This is supported by a chart review for the level of care and correcting billing aspects of care for our patients while they are hospitalized. They provide provider support, appeals and denials and work directly with insurance payors to recuperate payment for patient care. There is limited patient interaction. · Primary work location is an onsite position managing patients in the Emergency room.· Positions are a 10 hour shift and work a set schedule that includes weekends and Holiday patient Care Management- SRMC Campus:Supports patient's inpatient stay through care coordination, dischargeplanningand proactively discharging patient safely to the next level of care when medically ready. RN Case Managers areassigned to units andhave a 1:25-30 patient ratio andsupport forall age groups. RN CM attends daily multidisciplinary rounds and worksalongsideSocial Work case manager, case management assistants, providers, therapist, and pharmacistdaily. This work is done primarily in personon their assigned units. · Most positions will be Monday- Friday from 8-430pm. · Weekend and PRN availability · There isrequiredon-callforevenings andweekends (approximately 10 daysyear) · Holiday coverage (approximately2 Holidaysyear) MINIMUM QUALIFICATIONSEDUCATION:Nursing program (nationally accredited) graduateEXPERIENCE:1 year directly related experienceCERTIFICATIONS:RN MATRIX - Complete and maintain unitclinic based required certifications and competencies as listed in the department expectationsand or the unitclinic education matrixLICENSESCERTIFICATIONS:CPR Certification for HealthcareBLS Providers or for Professional Rescuers or must obtain within 30 calendar days of date of positionLicensed Registered Nurse (RN) in State of New Mexico or as allowed by reciprocal agreement by State of New MexicoCAP III - Clinical Advancement Program Level III requirements satisfiedTESTING REQUIREMENTS:Tuberculosis testing is completed upon hire and additionally as requiredPREFERRED QUALIFICATIONSPREFERRED EDUCATION:Bachelor's Degree of Science in NursingPREFERRED EXPERIENCE:Bilingual EnglishSpanishBilingual EnglishKeres, Tewa, Tiwa, Towa, Zuni, or NavajoSign-On Bonus AvailableRelocation Assistance AvailableDepartment: Registered Nurse