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RN Case Manager
Job
Zenotis Infotech Inc
Portales, NM (In Person)
Full-Time
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Job Description
Job Summary We are seeking an experienced RN Case Manager to support utilization review, discharge planning, and swing bed coordination services in an acute care setting. The ideal candidate will collaborate with physicians, nursing staff, patients, and families to ensure appropriate levels of care, efficient discharge planning, and compliance with Medicare, Medicaid, and insurance guidelines. Responsibilities Perform utilization review and case management activities for inpatient and observation patients. Coordinate discharge planning and transition-of-care services. Evaluate and screen patients for swing bed program admissions. Review Medicare, Medicaid, HMO, private insurance, and swing bed eligibility criteria. Communicate with patients and families to assess discharge needs and develop care plans. Participate in daily interdisciplinary rounds with physicians and healthcare team members. Collaborate with providers to facilitate timely and appropriate discharges. Maintain accurate case management documentation and discharge planning records. Coordinate swing bed placements and complete MDS documentation as required. Obtain referrals and prior authorizations for Home Health, SNF, Acute Rehab, DME/CME, and specialty appointments. Educate physicians and staff on admission status requirements, utilization guidelines, and documentation standards. Conduct InterQual reviews for all inpatient and observation admissions. Ensure compliance with facility, state, and federal regulations. Requirements Active and unrestricted RN License (required). Minimum 5 years of RN Case Management experience in an acute care setting. Experience with Utilization Review and Discharge Planning . Strong knowledge of Medicare, Medicaid, HMO, and private insurance regulations. Experience with InterQual criteria and medical necessity reviews. Knowledge of swing bed coordination and MDS documentation preferred. Proficiency with Meditech EMR preferred. Excellent communication, organizational, and problem-solving skills. Ability to work independently and collaboratively within a multidisciplinary team.