Clinical Case Manager - RN

Key Responsibilities

• Perform utilization review and clinical access evaluations for inpatient admissions

• Apply InterQual criteria to support level-of-care determinations

• Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate patient placement

• Support timely and appropriate care transitions across the continuum

• Identify opportunities to improve utilization, throughput, and resource management

• Document clinical reviews and care decisions accurately within Cerner systems

• Communicate findings and recommendations clearly to clinical teams

• Support compliance with regulatory and payer requirements related to utilization management

• Assist with coordination of patient flow across hospital departments

Qualifications

• Associate degree in Nursing or higher required

• Minimum of 2 years of acute care experience required

• Experience with InterQual and utilization review/management required

• Experience with CCM, ACM, or Milliman criteria preferred

• Basic Life Support (BLS) required upon submission

• Active New Mexico or compact RN license required prior to start (open to candidates without current licensure at time of application)

• Strong understanding of acute care workflows and hospital-based care coordination

Benefits

• Comprehensive medical, dental, and vision coverage

• Paid time off and holiday benefits

• Retirement savings program

• Continuing education and certification support

• Opportunity to work in a hospital-wide utilization management role within a multi-service acute care facility

• Collaborative interdisciplinary environment focused on improving patient flow and care efficiency

• Sign-on incentive available