Clinical Access Case Manager

Creating Life Better Here starts with you. At San Juan Regional Medical Center, we're more than a healthcare provider—we're a values-driven organization dedicated to delivering exceptional care. As a team member, you help fulfill our mission to make life better here for our community.The Clinical Access Case Manager (CACM) supports efficient patient flow and capacity management through timely placement of patients from all portals of entry including the emergency department, transferring facilities and procedural areas. CACMs provide a coordinated approach with the providers and Managing Resource Nurse (MRN) to determine appropriateness of admission and the appropriate status. Assures robust utilization review and appeals process.RequiredBehaviors:As you go about fulfilling this mission, your work habits and work relationships should embody SJRMC's values.  These values are our culture, our identity as an organization.Sacred Trust, Personal Reverence, Thoughtful Anticipation, Team Accountability and Creative Vitalityask 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.RequiredQualifications:Current RN license in the state of New MexicoMinimum of three (3) years’ experience in acute care requiredAssertive and diplomatic communication skillsSelf-motivated and accountableTeam OrientedPreferredQualifications:Bachelor’s Degree (BSN)Case Management experienceAccredited Case Manager CertificationDuties and Responsibilities:Management of ports of entry.Perform and document clinical reviews to determine medical necessity, using InterQual, and physician determination of length of stay (LOS).Collaborate with admitting provider, obtain and enter appropriate patient status orders in the EMR (i.e., inpatient, outpatient, or observation)Perform concurrent utilization review as assigned following contractual obligationsDenials and Appeals ManagementObservation Management:  Review observation cases every four (4) hours to assess for possible conversion to Inpatient or stability for discharge.Maintains accurate transfer and divert logSupports EMTALA complianceMaintain current knowledge of and follow Medicare and Medicaid requirementsProactively identifying, documenting, and escalating problems with over/under utilization of hospital resourcesDocuments avoidable days as appropriateCollaborates effectively with departmental staff to achieve goals and objectivesUtilizes internal or external Physician Advisor as needed to resolve level of care discrepanciesEach employee is responsible for implementing SJRMC’s Service Standards into their daily work:Safety, Courtesy, Effectiveness, and StewardshipOther duties as assignedPhysical Demands and Environmental Work Conditions:Physical:Minimum physical effort requiredIntermittent sitting with freedom of movementMinimal walking bending, lifting, pulling, and reachingMental:Fast paced environment, numerous interruptions, numerous phone callsFrequent periods of concentration with attention to details with frequent opportunity for diversification of tasksAbility to shift tasks to adjust to patient needs in a timely mannerWork performed in a modern, well-equipped environmentInterfaces with fellow employees, patients, and guests of hospital dailyAble to use various office equipment, including expertise in computer programs in performance of routine duties.