Case Manager - Inpatient-Acute Observation

Location Address:

Compensation Pay Range:

Minimum Offer $:

Maximum Offer for this position is up to $:

Summary:

Sign onandrelocation bonusesavailable for qualified candidates.

How you grow, learn and thrive matters here.
* Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
* Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
* Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
* Malpractice liability insurance
* Loan forgiveness through the New Mexico Higher Education Department
* EPIC electronic charting system

Type of Opportunity:

FTE:

Job Exempt:

Work Shift:

Job Description:

Presbyterian is seeking a Case Manager-Inpatient-Acute Observation. Applies Case Management principals in coordinating patient care across the continuum using assessment, care planning, implementation, coordination, monitoring and evaluation for cost effective and quality outcomes in a primarily inpatient setting, including complex discharge planning.
Performs Utilization Management clinical review to ensure that services rendered to members meet clinical criteria and are delivered in the appropriate setting. Utilizes clinical skills and knowledge to coordinate, document and communicate all aspects of the utilization/benefit management program. Performs care review both prospectively and retrospectively. Prospective review includes pre-service and concurrent services and procedures.

Some key responsibilities include:

• Receives, reviews, verifies and processes requests for approval of pre-service and concurrent services including verification of eligibility and availability of benefits.

• Identifies and advocates for members in caseload, referring to appropriate inpatient, outpatient and community resources including care coordination.

• Conducts an in-depth assessment which includes, psychosocial, physical, medical, environmental and financial parameters. Collaborates with Healthcare team to proactively develop, implement and document treatment and discharge plan with appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.

• Collaboratively formulates, implements, coordinates, monitors, and evaluates strategies with the healthcare team to address care management issues for specific patients and disease processes

• Applies utilization review criteria to assess and document the appropriateness of admission, continued stay, level of care, and readiness for discharge; refers cases that do not meet criteria to designated Physician Advisor. Promotes the appropriate use of clinical and financial resources in order to improve quality of care and patient/member satisfaction.

Qualifications:

• Bachelors degree in Nursing, Business, or Health related field preferred. RN license required.

• Five years of experience in relevant clinical nursing.

• Requires a minimum of two years of recent pertinent experience in clinical adult inpatient setting, or NICU for NICU team, or ICU, or Medical Surgical Hospital clinical nursing and utilization review or case management within the last 10 years.

• National certification in Case Management preferred within 3 years of hire.

• Computer knowledge to include Windows, Word, Excel, and database systems.

• Ability to analyze trends based on decision support systems.

• Knowledge in referral coordination to community & private/public resources.

• Good organizational and time management skills.

• Ability to articulate orally and in writing an understanding of complex issues and action plans, while best representing the organization professionally.

• Ability to work cooperatively with other employees and departments.

• Efficient and comfortable with computer electronic data entry and documentation.

• Ability to succinctly document using correct spelling and grammar.

• Able to summarize from medical clinical notes.

We're all about well-being, starting with yours.
Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.

Learn more about our employee benefits.

Presbyterian is committed to an inclusive and equitable environment where everyone is valued and empowered for success. We believe that our environment should reflect the diversity of our community.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system comprised of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 13,000 employees - including more than 1,200 providers and nearly 3,500 nurses.
Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.