Overview:
Now hiring a Case Manager-Inpatient
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
How you belong matters here.
We value our employees' differences and find strength in the diversity of our team and community.
At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.
Why Join Us
- Full Time - Exempt: Yes
- Job is based Remote Rev Hugh Cooper Admin Center
- Work hours: Days
- Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
Qualifications:
- Bachelors degree in Nursing, Business, or Health related field preferred. RN license required.
- Five years experience in clinical nursing.
- A minimum of two years of recent experience in acute clinical, utilization review, or case management within the last 10 years.
- National certification preferred within 3 years of hire.
- Computer knowledge to include Windows, Word, Excel, and database systems.
- Ability to analyze trends based on decision support systems.
- Business management skills to include, but not limited to, cost/benefit analysis, negotiation, & cost containment.
- Knowledge in referral coordination to community & private/public resources
Responsibilities:
- Identifies and advocates for members in caseload, referring to appropriate inpatient, outpatient and community resources including care coordination
- 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 negotiates rates with providers and vendors. Interfaces and negotiates with insurance companies and other payers to ensure payment for services. 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
- Performs other functions as required.
Benefits:
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Maximum Offer for this position is up to:
USD $44.49/Hr.
Compensation Disclaimer:
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
