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Travel RN Utilization Review Case Manager
Travel RN Utilization Review Case ManagerIntegrated Healthcare Services • Albuquerque, NM, US
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Travel RN Utilization Review Case Manager

Travel RN Utilization Review Case Manager

Integrated Healthcare Services • Albuquerque, NM, US
30+ days ago
Job type
  • Full-time
Job description

Job Description

Integrated Healthcare Services is seeking a travel nurse RN Case Management for a travel nursing job in Albuquerque, New Mexico.

Job Description & Requirements

  • Specialty : Case Management
  • Discipline : RN
  • Duration : 13 weeks
  • 40 hours per week
  • Shift : 8 hours
  • Employment Type : Travel

Floating between departments and or local locations within 20 miles is required.

Job Summary :

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. Responsible for facilitating members transfer from UNMH to Presbyterian Hospital when services are available.

Job Responsibilities :

  • Coordinates and facilitates the transfer of patients from UNMH to Presbyterian Hospital using the transfer center process flows (Presbyterian Care Connection).
  • Once decision for admission is made, collects clinical information to determine patients level of care.
  • Collaborates with Presbyterian Care Connection the transfer of member.
  • 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.
  • Performs cost-benefit analyses and refers to negotiations as needed, with non-contracted providers and vendors.
  • Generates reports, which demonstrate efficacy through direct cost-savings and outcome measures.
  • Actively participates in the development of clinical guidelines and pathways and incorporates processes into the role of nurse care coordinators.
  • Educates providers and other PHS / PHP departments on health management strategies and care coordination services.
  • Receives, reviews, verifies, and processes requests for approval of pre-service and concurrent services, supplies, and / or procedures, including but not limited to, inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, and rehabilitative therapies.
  • Performs retrospective review and conducts on-site or desktop audits at provider locations within New Mexico and completes all documentation accurately and appropriately.
  • Upon completion of medical record validation and other retrospective audits, compiles detailed findings and relevant supporting documentation for review.
  • Performs other functions as required.
  • RightSourcing IHS Job ID #3-36489267. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined.

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    Rn Utilization Review • Albuquerque, NM, US

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