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Minimum Skills/Requirements

Current RN License required, bachelor’s degree in health care related field required or must obtain degree within five years. Three to five years experience in acute care setting required. Knowledge of utilization management, HCFA guidelines, and home nursing is highly desirable.

Primary Job Functions

• Facilitate a team approach to the coordination and cost effective delivery of quality care and services across the continuum.

• Assess patient and family needs; develop, document, and implement plans which provide appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.

• Apply utilization review criteria to assess and document the appropriateness of admission, continued stay, level of care, and readiness for discharge; refer cases that do not meet criteria to designated Physician Advisor; collaborate with physician, care givers, patient, family, and payer to pro-actively develop and implement discharge plan.

• Interface and negotiate with insurance companies and other payers to ensure payment for services.

• Refer to appropriate inpatient, outpatient, and community resources.

• Promote the appropriate use of clinical and financial resources in order to improve the quality of care and patient satisfaction.

• Ensure that the quality of patient care is maintained or surpassed by collecting quality indicators and clinical path variance data; report and identify data that indicate potential areas for improvement of care and services provided within the system.

• Collaborate with physicians, care providers, and ancillary support services to foster a team approach to address care management issues for specific patients and disease processes.

• Educate physicians, nurses, ancillary support staff, patients, and families regarding Care Coordination role; serve as utilization management resource.

• Performs other functions as required.

• Location: Albuquerque
• Compensation: $35-$40 Hr.
• Principals only. Recruiters, please don't contact this job poster.
• Phone calls about this job are ok.
• Please do not contact job poster about other services, products or commercial interests.