Clinical Case Manager - RN

Career Land Center•Farmington, NM

2d•Onsite

About The Position

A Healthcare Facility is seeking a Clinical Access Case Manager (RN) to support hospital-wide utilization management and care coordination. This role focuses on clinical access and utilization review across all inpatient populations. The Case Manager applies established criteria to support appropriate admission status, level-of-care decisions, and safe transitions throughout the patient stay. Work is completed in collaboration with physicians, nurses, and interdisciplinary teams throughout the facility, using InterQual criteria and Cerner-based systems to guide decision-making and documentation.

Requirements

Associate degree in Nursing or higher required
Minimum of 2 years of acute care experience required
Experience with InterQual and utilization review/management required
Basic Life Support (BLS) required upon submission
Active New Mexico or compact RN license required prior to start (open to candidates without current licensure at time of application)
Strong understanding of acute care workflows and hospital-based care coordination

Nice To Haves

Experience with CCM, ACM, or Milliman criteria preferred

Responsibilities

Perform utilization review and clinical access evaluations for inpatient admissions
Apply InterQual criteria to support level-of-care determinations
Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate patient placement
Support timely and appropriate care transitions across the continuum
Identify opportunities to improve utilization, throughput, and resource management
Document clinical reviews and care decisions accurately within Cerner systems
Communicate findings and recommendations clearly to clinical teams
Support compliance with regulatory and payer requirements related to utilization management
Assist with coordination of patient flow across hospital departments