Regional Claims Manager jobs in Las Cruces, NM

If you're looking for a place to call home and grow, Three Crosses Regional Hospital is looking for you! We are looking for a Case Manager for our Case Management Team that is committed to clinical excellence and building a patient-centered culture.

Three Crosses Regional Hospital is an advanced independent healthcare organization led by a local team of professionals dedicated to high quality patient care and being the first choice of patients and providers in the communities we serve.

We are dedicated to hiring team members that will adapt to our culture, pride themselves in professionalism, integrity, transparency, two-way communication, and ensuring the safety and well-being of our patients and staff.

The Case Manager will provide clinical case management services focused on enhancing patient-centered care and maximizing outcomes across from the patient care continuum from admissions to post-discharge.  The Case Manager will collaborate with the clinical team to assist in development, planning, coordination, and administration of the activities of clinical review, discharge planning, resource utilization and utilization review. 

Responsibilities:

• Assumes a leadership role and collaborates with the interdisciplinary team to manage care, through criteria driven processes, for the appropriate level of care, patient status, discharge needs and resource utilization.
• Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care.
• Provides compassion to the patient and the patient’s family members.
• Develops and ensures delivery of patient care including assessment, planning, implementation, and evaluation of patient outcomes. 
• Revises plan of patient care as needed.
• Performs utilization management reviews and communicates information to third party payers. 
• Assesses patients’ post discharge needs and facilitates the provision of services necessary to meet identified needs. 
• Facilitate referral and linkage process to appropriate services.

Education and Experience:

• Required: Associates degree in Nursing from an accredited school of nursing
• Required: Current RN licensure in the State of New Mexico or compact state in Nursing
• Required: Current BLS certification 
• Required: 3 years Case Management experience in a health care environment
• Preferred: 5 years experience in a health care environment
• Preferred: Experience with electronic and case management documentation systems; willing to train

Three Crosses Regional Hospital is an equal opportunity employer.