Utilization Review + Swing Bed Case Manager

Job Details:

Title:

Utilization Review +

Swing Bed Case Manager Location:

Portales, NM 88130

Duration :

13 Weeks of contract

Shift :

08:00 AM-16:30

Pm Requirements :

5+ years of experience

Key Responsibilities:

Coordinate comprehensive case management, discharge planning, and utilization review activities for hospitalized patients. Evaluate and screen potential admissions for eligibility into the Swing Bed Program. Maintain current knowledge of Medicare, Medicaid, HMO, private insurance, and Swing Bed coverage requirements and criteria. Initiate and maintain ongoing communication with patients and families to assess discharge needs and facilitate safe transitions of care. Participate actively in daily interdisciplinary rounds with physicians, nursing staff, and ancillary departments. Collaborate with physicians regarding treatment plans and anticipated discharge dates to promote timely patient progression. Document case management activities, utilization review findings, and discharge planning updates throughout the patient's stay. Coordinate Swing Bed placements and complete Minimum Data Set (MDS) documentation as required. Assist with obtaining referrals, prior authorizations, and coordination of services including Home Health, Durable Medical Equipment (DME), Skilled Nursing Facilities (SNF), Acute Rehabilitation, and specialty appointments. Educate physicians and clinical staff regarding appropriate admission status, utilization management requirements, and documentation standards. Perform InterQual reviews for all inpatient and observation patients to ensure appropriate level-of-care determinations and regulatory compliance. Collaborate with healthcare team members to optimize patient outcomes, resource utilization, and reimbursement accuracy.

Qualifications:

Current Registered Nurse (RN) license preferred. Previous experience in case management, discharge planning, utilization review, care coordination, or swing bed programs preferred. Knowledge of Medicare, Medicaid, managed care, and commercial insurance regulations. Experience with InterQual criteria and utilization management processes. Familiarity with MDS documentation and Swing Bed Program requirements preferred. Strong communication, organizational, and critical-thinking skills. Ability to work collaboratively within a multidisciplinary healthcare team. JY01

Pay:

$2,400.00 - $2,500.00 per week

Work Location:

In person