RN Case Manager
Company: Presbyterian Healthcare Services
Location: Albuquerque
Posted on: May 8, 2025
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Job Description:
Overview Presbyterian is seeking a RN Case Manager that will
provide clinically-based case management to support the delivery of
effective and efficient patient care based in the Emergency
Department by completing Utilization Review for Level of Care and
Initial Assessments. The role integrates utilization management,
care coordination, and transition planning functions. The Case
Manager has the overall accountability for a designated case load
and plans effectively in order to meet patients needs, manage the
length of stay, and promote efficient utilization of resources. In
collaboration with the interdisciplinary team, the case manager
supports the physician in facilitating patient care with the
objective of enhancing the quality of patient outcomes and patient
satisfaction while managing the cost of care and providing timely
and accurate information to payers. Sign on and relocation bonuses
available for qualified candidates. How you grow, learn and thrive
matters here. Educational and career development options, including
tuition and certification reimbursement, scholarship opportunities
Wearable alarm badge (a wearable badge that allows nurses to
quickly and discreetly call for help when safety is a concern)
Shift differentials for nights and weekends Differentials for
higher education, certifications and various lead roles Malpractice
liability insurance Loan forgiveness through theNew Mexico Higher
Education Department EPIC electronic charting system Type of
Opportunity: Full Time FTE: 1.000000 Exempt: No Work Schedule: 8 or
10 hour shifts - Days or Nights available Qualifications RN-Case
Management I: Associate Degree in Nursing Registered Nurse - State
of New Mexico or Compact State Nursing License required. National
Case Management certification preferred Two years clinical nursing
experience in relevant clinical practice area with utilization
review or case management experience preferred. RN-Case Management
II: Registered Nurse with Bachelors of Science in nursing (BSN)
degree or Registered Nurse with Associates degree in nursing (ADN)
plus five years utilization review or case management experience
required. Registered Nurse - State of New Mexico or Compact State
Nursing License required.. National Case Management certification
preferred Two years clinical nursing experience in relevant
clinical practice area with utilization review or case management
experience preferred. RN-Case Management III: Registered Nurse with
Masters of Science in nursing (MSN) degree or Registered Nurse with
Bachelors in nursing (BSN) plus five years utilization review or
case management experience required. Registered Nurse - State of
New Mexico or Compact State Nursing License required. National Case
Management certification preferred Two years clinical nursing
experience in relevant clinical practice area with utilization
review or case management experience preferred. RN-Case Management
IV: Registered Nurse with Masters of Science in nursing (MSN)
degree plus five years utilization review or case management
experience or Registered Nurse with Bachelors in nursing (BSN) plus
ten years utilization review or case management experience
required. Registered Nurse - State of New Mexico or Compact State
Nursing License required. National Case Management certification
preferred Two years clinical nursing experience in relevant
clinical practice area with utilization review or case management
experience preferred. Responsibilities Interviews and assesses each
patient, family or other designated person(s) within 48 hours of
admission in order to obtain financial, emotional, physical,
social, functional and health care needs in order to define and
recommend potential discharge plans, manage patient and family
expectations, identify readmission risk and target interventions to
reduce risk for readmission, and identify, adjust and manage
barriers to discharge. Applies approved clinical criteria to
monitor appropriateness of admissions and continued stays to ensure
a clear status determination. Refers cases and issues to Case
Management Medical Director based on departmental standards.
Demonstrates skill in communicating with physicians the necessary
documentation required to demonstrate medical necessity. Elevates
to Supervisor and/or Medical Director all patients not meeting
criteria after discussion with physician. Demonstrates skill in
educating patient, family and interdisciplinary team regarding
post-acute care options, status determination, and other care
coordination services. Develops implements, coordinates, monitors
and evaluates preliminary and final discharge plans with the
interdisciplinary team, patient and family. Arranges and/or
facilitates identified discharge needs and services of patients and
ensures timely intervention to prevent delays in service and
transition of care. Ensures all elements of the plan of care have
been communicated to the patient/family and members of the
healthcare team to assure continuity of care. Participates and
facilitates care progression in daily multidisciplinary rounds and
addresses target length of stay with health care providers to
achieve complete delivery of services within prescribed timeframe.
Monitors length of stay and takes action to mitigate
overutilization and elevates to medical director as needed.
Presents and actively participates in complex rounds, discharge
planning huddles, process improvement teams, department specific
initiatives and department meetings. Identifies patients and
families with complex psychosocial issues and refers them to the
Social Worker as appropriate. Demonstrates skill and success in
collaboration with Social Work partner. Facilitates and leads
patient/family and provider care conferences as needed. Documents
results of assessments, status assignment, and interventions and
discharge planning in the medical record according to departmental
policies and procedures. Ensures safe care to patients adhering to
policies, procedures, and standards within budgetary
specifications, including time management, supply management,
productivity and accuracy of practice. Promotes individual and
departmental professional growth and development by meeting
requirements for and facilitating continuing education, skills
competency. Supports departmental based goals which contribute to
the success of the organization. Serves as a mentor, preceptor,
mentor and resource to less experienced staff. Benefits Benefits
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. Our culture is one of knowing and respecting our
patients, members, and each other. We capture this in our Promise
and CARES commitments 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. Maximum Offer for this position is up to USD $51.41/Hr.
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. Employment Type: Full Time
Keywords: Presbyterian Healthcare Services, Albuquerque , RN Case Manager, Executive , Albuquerque, New Mexico
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