Clinical Case Manager - RN

Job Description

A Healthcare Facility is seeking a Clinical Access Case Manager (RN) to support hospital-wide utilization management and care coordination. 

Position Overview

This role focuses on clinical access and utilization review across all inpatient populations. The Case Manager applies established criteria to support appropriate admission status, level-of-care decisions, and safe transitions throughout the patient stay. 

Work is completed in collaboration with physicians, nurses, and interdisciplinary teams throughout the facility, using InterQual criteria and Cerner-based systems to guide decision-making and documentation.

Key Responsibilities

• Perform utilization review and clinical access evaluations for inpatient admissions
• Apply InterQual criteria to support level-of-care determinations
• Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate patient placement
• Support timely and appropriate care transitions across the continuum
• Identify opportunities to improve utilization, throughput, and resource management
• Document clinical reviews and care decisions accurately within Cerner systems
• Communicate findings and recommendations clearly to clinical teams
• Support compliance with regulatory and payer requirements related to utilization management
• Assist with coordination of patient flow across hospital departments

Qualifications

• Associate degree in Nursing or higher required
• Minimum of 2 years of acute care experience required
• Experience with InterQual and utilization review/management required
• Experience with CCM, ACM, or Milliman criteria preferred
• Basic Life Support (BLS) required upon submission
• Active New Mexico or compact RN license required prior to start (open to candidates without current licensure at time of application)
• Strong understanding of acute care workflows and hospital-based care coordination

Benefits

• Comprehensive medical, dental, and vision coverage
• Paid time off and holiday benefits
• Retirement savings program
• Continuing education and certification support
• Opportunity to work in a hospital-wide utilization management role within a multi-service acute care facility
• Collaborative interdisciplinary environment focused on improving patient flow and care efficiency
• Sign-on incentive available