- As you go about fulfilling this mission, your work habits and work relationships should embody SJRMC's values.
- Current RN or LPN license in the state of New Mexico
- Minimum of five (5) years' experience in acute care required
- Assertive and diplomatic communication skills
- Self-motivated and accountable
- Bachelor's Degree (BSN)
- Case Management experience
- Management of ports of entry. Perform and document clinical reviews to determine medical necessity, using InterQual, and physician determination of length of stay (LOC).
- Receive and review physician orders on all patients coming into SJRMC and determines the accuracy of the patient status assigned, (i.e., inpatient, outpatient, or observation)
- Perform concurrent utilization review as assigned following contractual obligations
- Denial Management
- Observation Management
- Maintain current knowledge of and follow Medicare and Medicaid requirements
- Proactively identifying, documenting, and escalating problems with over/under utilization of hospital resources
- Collaborates effectively with departmental staff to achieve goals and objectives
- Utilizes internal or external Physician Advisor as needed to resolve level of care discrepancies
- Perform other duties as assigned
- Each employee is responsible for implementing SJRMC's Service Standards into their daily work: Safety, Courtesy, Effectiveness, and StewardshipPhysical Demands and
- Minimum physical effort required
- Intermittent sitting with freedom of movement
- Frequent walking
- Minimal bending, lifting, pulling, and reachingMental:
- Frequent periods of concentration with attention to details
- Frequent opportunity for diversification of tasks
- Ability to shift tasks to adjust to patient needs in a timely manner
- Work performed in modern, well-equipped environment
- Interfaces with fellow employees, patients, and guests of hospital daily
- Able to use various office equipment, including expertise in computer programs in performance of routine duties
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Clinical Access Case Manager - Farmington, United States - San Juan Regional Medical Center
Description
Love what you do; Love where you liveThe Clinical Access Case Manager will ensure regulatory compliance with CMS Conditions of Participation with regard to Utilization Management.
Required Behaviors:
Sacred Trust, Personal Reverence, Thoughtful Anticipation, Team Accountability, and Creative Vitality ask more of us than merely completing some list of tasks.
Our values ask for a deeper level of commitment, and what is asked of us we freely give because we believe in our mission.
Required Qualifications:
Team OrientedPreferred Qualifications:
Accredited Case Manager CertificationDuties and Responsibilities:
Environmental Work Conditions:
Physical:
