Clinical Access Case Manager

San Juan Regional Medical Center•Farmington, NM

About The Position

The Clinical Access Case Manager (CACM) supports efficient patient flow and capacity management by coordinating timely placement of patients arriving through all portals of entry, including the emergency department, transferring facilities, and procedural areas. In coordination with providers and the Managing Resource Nurse (MRN), the CACM determines whether admission is appropriate and identifies the appropriate patient status. The role also ensures a robust utilization review and appeals process. The position is expected to embody San Juan Regional Medical Center’s values of Sacred Trust, Personal Reverence, Thoughtful Anticipation, Team Accountability, and Creative Vitality, and to implement the organization’s Service Standards of Safety, Courtesy, Effectiveness, and Stewardship in daily work. Work takes place in a modern, well-equipped environment and involves daily interaction with employees, patients, and hospital guests. The position requires working in a fast-paced environment with frequent interruptions and phone calls, sustained attention to detail, and the ability to shift tasks in response to patient needs.

Requirements

Current RN license in the state of New Mexico.
At least three years of acute care experience.
Assertive and diplomatic communication skills.
Self-motivated and accountable.
Team-oriented.

Nice To Haves

Bachelor’s degree in nursing (BSN).
Case Management experience.
Accredited Case Manager Certification.

Responsibilities

Manage patient portals of entry.
Perform and document clinical reviews to determine medical necessity using InterQual and physician determination of length of stay (LOS).
Collaborate with the admitting provider to obtain and enter appropriate patient status orders in the EMR, including inpatient, outpatient, or observation status.
Perform concurrent utilization review as assigned, following contractual obligations.
Manage denials and appeals.
Review observation cases every four hours to assess possible conversion to inpatient status or stability for discharge.
Maintain an accurate transfer and divert log.
Support EMTALA compliance.
Maintain current knowledge of and follow Medicare and Medicaid requirements.
Proactively identify, document, and escalate problems with over- or under-utilization of hospital resources.
Document avoidable days as appropriate.
Collaborate effectively with departmental staff to achieve goals and objectives.
Use an internal or external Physician Advisor as needed to resolve level-of-care discrepancies.
Implement SJRMC’s Service Standards—Safety, Courtesy, Effectiveness, and Stewardship—in daily work.
Perform other duties as assigned.