RN-Utilization Review & Swing Bed Case Manager

RN-Utilization Review & Swing Bed Case Manager 5.0 5.0 out of 5 stars Portales, NM $55

• $60 an hour
• Contract Learn beyond Consulting 5 reviews $55
• $60 an hour

• Contract Job Title:

  RN

•

Utilization Review & Swing Bed Case Manager Location:

Portales, New Mexico Assignment Length:

13

Weeks Schedule:

Monday-Friday, 8:00 AM

• 4:30

PM Pay Rate:

$60/hourly Mandatory Qualifications for This Job Active and unrestricted Registered Nurse (RN) License in the State of New Mexico or compact state eligibility. Minimum 5 years of experience in: Utilization Review (UR) Case Management Discharge Planning Care Coordination Swing Bed Program Management Strong knowledge of: Medicare Medicaid Managed Care Organizations (MCO/HMO) Private Insurance Observation (OBS) and Inpatient (IP) criteria Experience using InterQual Criteria for medical necessity reviews. Experience with MDS Documentation and Swing Bed coordination. Proficiency with Meditech EMR or similar electronic medical record systems. Preferred Qualifications Certified Case Manager (CCM) preferred. Experience in rural hospital or critical access hospital settings preferred. Experience with appeals, denials management, and revenue cycle optimization preferred. Roles and ResponsibilitiesUtilization Review & Care Coordination Perform utilization review activities for all inpatient and observation patients. Apply InterQual Criteria to determine appropriate level of care and admission status. Monitor medical necessity, resource utilization, and compliance with payer requirements. Educate physicians and clinical staff regarding utilization management guidelines and documentation requirements. Assist with denial prevention and appeals management activities. Swing Bed Program Management Evaluate and screen patients for admission into the Swing Bed Program. Coordinate swing bed admissions, transfers, and ongoing care planning. Ensure compliance with Medicare, Medicaid, and payer-specific swing bed requirements. Complete and maintain required Minimum Data Set (MDS) documentation. Collaborate with interdisciplinary teams to optimize patient outcomes and length of stay. Case Management & Discharge Planning Develop individualized discharge plans for patients and families. Conduct ongoing assessments of discharge needs and barriers to care.

Coordinate referrals and transitions to:

Home Health Services Skilled Nursing Facilities (SNF) Acute Rehabilitation Facilities Durable Medical Equipment (DME/CME) Providers Specialty Appointments and Community Resources Obtain prior authorizations and payer approvals for post-acute services. Facilitate timely and safe patient discharges. Interdisciplinary Collaboration Participate actively in daily multidisciplinary rounds. Collaborate with physicians, nursing staff, therapy teams, and ancillary departments. Maintain ongoing communication regarding treatment plans and discharge goals. Advocate for patients and families throughout the continuum of care. Document case management interventions, utilization reviews, and discharge planning activities accurately and timely. Compliance & Quality Improvement Ensure compliance with federal, state, hospital, and payer regulations. Support quality improvement initiatives related to utilization management and patient flow. Monitor length of stay, readmissions, and care transition outcomes. Maintain accurate and complete documentation to support reimbursement and regulatory requirements. #RNCaseManager #UtilizationReview #DischargePlanning #SwingBedCoordinator #CareCoordination #InterQual #MDSDocumentation #Medicare #Medicaid #PriorAuthorization #AcuteCareRN #HospitalCaseManagement #MedicalNecessityReview #ManagedCare #AppealsAndDenials #RevenueCycleManagement #CareTransitions #PatientAdvocacy #Meditech #HealthcareManagement #ClinicalDocumentation #SkilledNursingFacility #HomeHealth #AcuteRehabilitation #UtilizationManagement #RegisteredNurse #CaseManagement #SwingBedCaseManager #ObservationReview #InpatientReview#

ALITE2026

Pay:

$55.00

• $60.

00 per hour

Benefits:

Referral program

Work Location:

On the road