RN Case Management Utilization Review - Care Coordination

Are you a Registered Nurse with a passion for case management and utilization review? Presbyterian Healthcare Services is seeking a highly skilled and dedicated RN to join our team as a Case Management Utilization Review - Care Coordination Nurse. In this role, you will be responsible for ensuring the efficient and effective use of resources while promoting high-quality and patient-centered care. We are looking for individuals who are compassionate, organized, and have excellent communication and critical thinking skills. If you are ready to make a positive impact on patient care and join a dynamic healthcare organization, we encourage you to apply now!

• Conduct thorough utilization reviews of patient cases to assess the appropriate use of resources and identify potential areas for improvement
• Collaborate with interdisciplinary teams to develop and implement individualized care plans for patients
• Monitor and track patient progress and outcomes, making adjustments to care plans as needed
• Communicate with insurance companies and other third-party payers to obtain authorization for necessary services and ensure timely reimbursement
• Educate patients and their families on available resources and support services to facilitate a smooth transition between care settings
• Act as a liaison between patients, healthcare providers, and payers to promote effective communication and coordination of care
• Utilize evidence-based practices and clinical guidelines to ensure the delivery of high-quality, cost-effective care
• Participate in case conferences and provide input on complex patient cases to promote best practices and optimal outcomes
• Stay current on changes in healthcare policies, regulations, and reimbursement models to ensure compliance with standards and guidelines
• Maintain accurate and thorough documentation of patient care, utilization review processes, and outcomes for quality improvement purposes.

According to JobzMall, the average salary range for a RN Case Management Utilization Review - Care Coordination in Albuquerque, NM, USA is between $64,000 to $85,000 per year. This may vary depending on factors such as years of experience, education level, and specific job responsibilities. Some employers may also offer additional benefits and bonuses.

Presbyterian Healthcare Services is a private not-for-profit health care system and health care provider in the State of New Mexico. It owns and operates 8 hospitals in 7 New Mexico communities. It also operates Presbyterian Health Plan.