Case Manager Registered Nurse - RN Case MGMT- Utilization Review- IN PERSON- Up to $25K SIGN ON BONUS

Utilization Review Rn- Case ManagementPosition: Utilization Review RN- Case Management (IN PERSON) - Up to $25K SIGN ON BONUSLocation: Farmington, NM **Onsite- In personSchedule: DaysResponsibilitiesMeets expectations aligned with organizational competency models, including Leader of Self, Leader of Others, or Leader of Leaders.Conducts prior authorization reviews to assess whether proposed services are covered and medically necessary for the beneficiary.Promotes quality, cost-effective outcomes through prior authorization and concurrent review using evidence-based clinical guidelines.Identifies and escalates cases involving potential quality of care concerns, questionable admissions, or extended lengths of stay to the Medical Director.Refers beneficiaries with complex or chronic conditions for care coordination, including transition of care, disease management, and behavioral health support as appropriate.Adheres to all applicable HIPAA regulations to ensure the privacy and security of Protected Health Information (PHI).Maintains confidentiality of sensitive data and ensures compliance with national health information standards.Reviews and analyzes clinical documentation submitted by providers to determine medical necessity, appropriateness, and efficiency of services, procedures, and facility use.Conducts provider outreach to coordinate post-discharge care, encourage use of in-network services, support durable medical equipment needs, and perform necessary follow-up.Applies the nursing process and critical thinking skills to oversee services and evaluate care options.Job RequirementsGraduate of an accredited vocational nursing program or equivalent requiredAssociate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) preferredExperience3–5 years of nursing experience preferredProficiency with Microsoft Office applications (Outlook, Teams, Word, Excel) requiredGeneral computer proficiency requiredLicenses/CertificationsActive LVN license in the state of employment or compact license requiredActive RN license in the state of employment or compact license preferred