Utilization Review & Swing Bed RN Case Manager
Portales, NM
PRIDE Health
5x8 hrs, Days
Referral Bonus

Utilization Review and Swing Bed Case Manager

Location: Portales, New Mexico
Employment Type: Contract
Contract Length: 13 weeks

Job Summary

• Manage routine case management, discharge planning, swing bed coordination, and utilization review duties.
• Evaluate and screen potential admissions to the swing bed program.
• Understand criteria for Medicare, Medicaid, HMO, swing bed, and private insurance coverage.
• Maintain ongoing communication with residents and their families to assess discharge needs.
• Participate actively in daily rounds with bedside staff, physicians, and ancillary team members.
• Communicate with physicians to facilitate timely discharges.
• Document updates and discharge planning as part of ongoing patient review.
• Collaborate with the healthcare team on swing bed placement and complete Minimum Data Set (MDS) documentation as needed.
• Assist with obtaining referrals and prior authorizations for Home Health Care, CME, Skilled Nursing Facility (SNF), acute rehab, and appointments.
• Educate physicians and staff on appropriate levels of care, utilization, and required documentation for admission status.
• Run InterQual criteria for each inpatient and observation patient admitted to the floor.

Shift

• 8:00 AM to 4:30 PM

Required Qualifications

• Valid RN license in New Mexico
• Utilization Review experience for 5 years, including experience within the last year
• Associate of Science in Nursing or Associate Degree in Nursing

Specialty

• Mid-Revenue Cycle Solutions / Utilization Review / Case Management