Utilization Management Nurse Jobs in New Mexico
Epitec, Inc
$39 - $41
Albuquerque, NM
We’re seeking an experienced Registered Nurse to support Utilization Management (UM) activities, focused on medical necessity review, regulatory compliance, and appropriate use of healthcare resources. Evaluate requests for admissions, procedures, drugs/biologics, DME, home health, and OON services.
Epitec, Inc
Albuquerque, NM
We’re seeking an experienced RN Case Management Senior Analyst to independently manage complex cases and support high?quality, cost?effective healthcare outcomes across the continuum of care. What You’ll DoIndependently manage an assigned caseload using advanced nurse case management and utilization management principles.
St. Anthony HC and Rehab Ctr
$40 - $43
Clovis, NM
Responsibilities: The MDS Nurse -- RN manages the overall process and tracking of all Medicare/Medicaid case-mix documents to ensure appropriate reimbursement for all services provided within the nursing.*Maintain an accurate schedule of all MDS assessments to include the proper reference dates throughout the patient stay and ensures the accurate and timely submission of the MDS assessments including case-mix, OBRA and OSRA required assessments. *Serve as the nursing center resource for MDS/RUGs and state case-mix systems providing staff case-mix education and instruction on MDS terminology and format.
Bloomfield
$40 - $45
Bloomfield, NM
Facilitate a person-centered team approach to skin and wound prevention and management, working alongside nursing center leadership, nursing staff, physicians, therapists, dietitians, and families. As our Skin Health Team Lead, you will be a champion for skin integrity, working closely with our interdisciplinary team, patients, and their families to prevent and effectively manage skin and wound concerns.
Belen Meadows HC and Rehab Ctr
$40
Belen, NM
Facilitate a person-centered team approach to skin and wound prevention and management, working alongside nursing center leadership, nursing staff, physicians, therapists, dietitians, and families. As our Skin Health Team Lead, you will be a champion for skin integrity, working closely with our interdisciplinary team, patients, and their families to prevent and effectively manage skin and wound concerns.
CHRISTUS Health
Santa Fe, NM
Work effectively with other healthcare team members to optimize interventions and manage community outreach to promote disease awareness and the offerings of the specific clinic focus. Customer Relations: Exhibits behaviors and actions that create a high level of patient/customer satisfaction, positive patient/customer relations, and respect for the patient’s/customer’s rights needs, and confidentiality.
Presbyterian Healthcare Services
$95388.8 - $149364.8
Rio Rancho, NM
This role is responsible for managing daily clinic operations, leading and developing staff, ensuring regulatory compliance, optimizing patient flow, and collaborating closely with oncology providers and interdisciplinary teams to support exceptional outcomes for patients undergoing cancer treatment. The Nurse Manager for the Oncology Infusion Clinic provides clinical, operational, and administrative leadership to ensure the delivery of safe, high-quality, patient-centered infusion therapy services.
Presbyterian Healthcare Services
$83366.4 - $127275.2
Albuquerque, NM
Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more. This role assists with daily operations, staff supervision, patient safety initiatives, quality improvement, and regulatory compliance to ensure the delivery of high-quality perioperative care.
Presbyterian Healthcare Services
Ruidoso, NM
As the Medical Surgical/ICU Nursing Manager you will assist the Department Director in planning, directing and coordinating the operational, financial and personnel activities of the designated departments as well as provide clinical and operational leadership for areas assigned. Presbyterian is seeking a dedicated Medical Surgical/ICU Nurse Manager to join our team at Lincoln County Medical Center in Ruidoso, New Mexico, a community known for its fresh mountain air, outdoor adventure, and relaxed pace of life.
Fresenius Medical Care
Farmington, NM
Facilitate timely workup of patients for access management, dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination of care with the multidisciplinary renal team. Frequently interacts with subordinate supervisors, customers, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers.
TalentBurst, Inc.
$1188 - $1224
Albuquerque, NM
Summary: Under the direction of the RN Nursing Supervisor, Unit Manager, ADON or ADON – Unit, or Center Nurse Executive (Nurse Leader), the Registered Nurse (RN) delivers efficient and effective nursing care while achieving positive clinical outcomes and patient/family satisfaction. He/she operates within the scope of practice defined by the State Nurse Practice Act and delegates aspects of patient care to LPNs and CNAs consistent with their scope of practice.
TalentBurst, Inc.
$1763
Gallup, NM
Summary: Under the direction of the RN Nursing Supervisor, Unit Manager, ADON or ADON – Unit, or Center Nurse Executive (Nurse Leader), the Registered Nurse (RN) delivers efficient and effective nursing care while achieving positive clinical outcomes and patient/family satisfaction. He/she operates within the scope of practice defined by the State Nurse Practice Act and delegates aspects of patient care to LPNs and CNAs consistent with their scope of practice.
TalentBurst, Inc.
$1260 - $1296
Gallup, NM
Location: Gallup, NM Summary: Under the direction of the RN Nursing Supervisor, Unit Manager, ADON or ADON – Unit, or Center Nurse Executive (Nurse Leader), the Registered Nurse (RN) delivers efficient and effective nursing care while achieving positive clinical outcomes and patient/family satisfaction. He/she operates within the scope of practice defined by the StateNurse Practice Act and delegates aspects of patient care to LPNs and CNAs consistent with their scope of practice.
TalentBurst, Inc.
$1188 - $1224
Bloomfield, NM
Summary: Under the direction of the RN Nursing Supervisor, Unit Manager, ADON or ADON – Unit, or Center Nurse Executive (Nurse Leader), the Registered Nurse (RN) delivers efficient and effective nursing care while achieving positive clinical outcomes and patient/family satisfaction. He/she operates within the scope of practice defined by the State Nurse Practice Act and delegates aspects of patient care to LPNs and CNAs consistent with their scope of practice.
Ambition 24Hours
$110000 - $140000
Las Cruces, NM
The Director of Case Management will drive patient transitions through the continuum of care in a timely and cost-effective manner, ensuring both clinical outcomes and operational efficiency are optimised. Our client, a community hospital in southern New Mexico, is seeking an experienced Director of Case Management to lead the department through the full patient care continuum.
CHRISTUS Health
Santa Fe, NM
Manages subordinate personnel, prepares clinic budget, ensures data accuracy, prepares financial analyses, handles customer service issues and maintains provider/staff communications. Works closely with leadership to develop, implement, and maintain programs that enhance quality of care and achieve a high level of patient and provider satisfaction as well as meeting budgeted financial clinic performance.
CHRISTUS Health
Alamogordo, NM
Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services.
Humana
$71100 - $97800
Santa Fe, NM
The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.
Sharecare
Santa Fe, NM
The Disease Management Nurse is also responsible during their interactions with participants for identification of those who are at risk for increasing acuity, and for educating the participant about that risk and if necessary and with the participants permission contacting their Primary Care Provider according to the disease management program intervention guidelines. By providing health education and resources, reviewing the provider’s plan of care with the member to ensure understanding and adoption, and utilizing motivation interviewing and behavior change techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes.
MRINetwork Jobs
Willard, NM
With over 300 days of blue skies a year, a walkable riverfront, public parks, golf courses, and hiking trails at your doorstep, it’s easy to recharge outside of work. As one of the most successful executive search firms in the country, The HealthCare Initiative is constantly working on several searches nationwide in the world of healthcare.
United Therapeutics
$168000 - $220000
Santa Fe, NM
Serve as an educational resource deployed to help ensure that physicians, nurses and other allied healthcare professionals are educated on PAH disease state and identify educational gaps that exist in the PAH space (e.g disease progression, risk stratification, therapies, clinical considerations etc.) and work to increase awareness around those identified gaps. + Ability to work independently and efficiently with minimal oversight; experience using time management skills such as prioritizing/organizing and tracking details while meeting deadlines of multiple projects without varying completion dates while traveling.
CHRISTUS Health
Santa Fe, NM
Graduate of an accredited school of nursing (BSN preferred) or Masters Degree in Social Work (MSW) required or demonstrated success in CHRISTUS Care Manager I Position for at least 5 years on top of the required experience in lieu of education required. The Care Manager (CM) II works in collaboration with the patient/family, physicians and multidisciplinary team members to ensure patient progression through the continuum of care and to develop a plan of care for each assigned patient from admission through discharge.
CHRISTUS Health
Santa Fe, NM
The Care Manager (CM) PRN works in collaboration with the patient/family, physicians, and multidisciplinary team members to ensure patient progression through the continuum of care and to develop a plan of care for each assigned patient from admission through discharge. Interviews patients/families to obtain information about social, emotional, and financial factors which may impact health status both prior to, and after, discharge and assess the patient’s current formal and informal support system as well as available benefits and resources.
Taphealthcare
$110000 - $140000
Las Cruces, New Mexico
Tap Healthcare Solutions partners with healthcare organizations to connect experienced leaders with opportunities that support operational excellence and high-quality patient care. The Director will lead a team of case managers and collaborate with physicians, nursing leadership, and administrative teams to improve operational efficiency and patient care delivery.
Highmark Health
Santa Fe, NM
This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._.
TalentBurst, Inc.
$972
Albuquerque, NM
Responsibilities: Patient Evaluation: Collects, reports and documents objective and subjective data; Observes conditions and reports changes in condition to RN; Care Planning: Contributes to establishing individualized patient goals; Assists in developing interventions to achieve goals; Implements the plan of care; Evaluates effectiveness of interventions to achieve patient goals and minimize re-hospitalizations; Participates in review and revision of plan of care; Provision of Direct Patient Care: Administers medications and performs treatments per physician orders; Communicates pertinent data to RN and/or physician; Summary: Under the direction of a Registered Nurse (RN), the Licensed Practical Nurse delivers efficient and effective nursing care while achieving positive clinical outcomes and patient/family satisfaction.
TalentBurst, Inc.
$1546
Clovis, NM
Responsibilities: Patient Evaluation: Collects, reports and documents objective and subjective data; Observes conditions and reports changes in condition to RN; Care Planning: Contributes to establishing individualized patient goals; Assists in developing interventions to achieve goals; Implements the plan of care; Evaluates effectiveness of interventions to achieve patient goals and minimize re-hospitalizations; Participates in review and revision of plan of care; Provision of Direct Patient Care: Administers medications and performs treatments per physician orders; Communicates pertinent data to RN and/or physician; Summary: Under the direction of a Registered Nurse (RN), the Licensed Practical Nurse delivers efficient and effective nursing care while achieving positive clinical outcomes and patient/family satisfaction.
TalentBurst, Inc.
$1224 - $1260
Albuquerque, NM
Summary: Under the direction of the RN Nursing Supervisor, Unit Manager, ADON or ADON Unit, or Center Nurse Executive (Nurse Leader), the Registered Nurse (RN) delivers efficient and effective nursing care while achieving positive clinical outcomes and patient/family satisfaction. He/she operates within the scope of practice defined by the State Nurse Practice Act and delegates aspects of patient care to LPNs and CNAs consistent with their scope of practice.
St. Anthony HC and Rehab Ctr
$30 - $33
Clovis, New Mexico
Responsibilities: The MDS Coordinator is responsible for the coordination and completion of clinical assessments, supporting documentation, care planning and transmitting the MDS, as required by federal and state regulations.*Manage all Medicare/Medicaid case-mix documents at the nursing center to assure appropriate reimbursement for services provided. Overview: Join the St Anthony's Healthcare team as a LPN MDS CoordinatorAt Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service.
Evolent
$32 - $37
Santa Fe, NM
Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.
Intermountain Health
$18.81 - $27.45
Santa Fe, NM
Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies.- and -Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.- and -Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
MTC
Chaparral, NM
Perform rescue functions at accidents, emergencies and disasters to include administering basic emergency medical aid, physically removing people away from dangerous situations, and securing and evacuating people from confined areas. If you are interested in employment opportunities with Management & Training Corporation and need assistance, please contact our staffing department through customersupport@mtctrains.com or 801-693-2888.
Community Health Systems
Roswell, NM
If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources. This role supervises nursing staff, coordinates care with healthcare teams, and maintains compliance with healthcare regulations and hospital policies while fostering a positive work environment and promoting professional development.
Community Health Systems
Roswell, NM
If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources. This role supervises nursing staff, coordinates care with healthcare teams, and maintains compliance with healthcare regulations and hospital policies while fostering a positive work environment and promoting professional development.
Lovelace Health System
Albuquerque, New Mexico
Lovelace Medical Center is an acute care hospital with 263 licensed beds, providing comprehensive care, including around-the-clock emergency care, surgical services, non-invasive robotic spine surgery, stroke care, radiology and oncology services. Responsibilities: The Case Manager RN is responsible for assessing and coordinating patient care across the continuum, utilizing accepted criteria and guidelines to manage benefits and determine the medical necessity of the services provided.
Concentra Career Choice
Santa Fe, New Mexico
Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
Concentra Career Choice
Santa Fe, New Mexico
Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
Concentra Career Choice
Albuquerque, New Mexico
Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
Concentra
Santa Fe, NM
Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
Concentra
Santa Fe, NM
Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
Concentra
Albuquerque, NM
Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
Home Care Providers of Texas
Albuquerque, NM
Executive Vice President, Southwest of Operations is a strategic, outcomes-driven executive responsible for the operational, clinical, financial, and regulatory performance of the company’s Home Health, Hospice, Personal Care Services and Therapy across Texas, New Mexico, and Indiana. Navigate state-specific requirements in Texas, New Mexico, and Indiana (licensure, staffing, supervision rules, emergency preparedness, scope of practice, Medicaid/MCO contracts), ensuring policies and training reflect state-level variations.
United Energy Workers Healthcare
$45 - $50
Espanola, New Mexico
The Clinical Manager oversees the clinical aspects of patient care, ensuring compliance with regulations and leading a team of healthcare professionals. Founded by the grandchildren of a former Department of Energy worker, we elevate the lives of energy workers with unwavering compassion and whole-person care.