Position: Utilization Review + Swing Bed Case Manager
Location: Portales, NM 88130
Contract Length: 13 Weeks
Shift: Days | 0800-1630
Guaranteed Hours: 40 Hours/Week
Minimum Years of Experience: 5
Job Summary:
We are seeking an experienced Utilization Review + Swing Bed Case Manager to support care coordination, discharge planning, utilization review, and swing bed program management. This role works closely with physicians, nursing staff, patients, families, and interdisciplinary teams to ensure appropriate patient placement and efficient transitions of care.
Responsibilities:
✔ Perform routine case management, discharge planning, swing bed coordination, and utilization review duties
✔ Evaluate and screen potential admissions for the facility’s swing bed program
✔ Review eligibility criteria for Medicare, Medicaid, HMO, swing bed, and private insurance coverage
✔ Communicate with residents and families to assess discharge needs and coordinate care plans
✔ Participate in daily rounds with bedside staff, physicians, and ancillary teams
✔ Collaborate with physicians to facilitate timely and effective discharge planning
✔ Maintain ongoing documentation updates and utilization reviews
✔ Manage swing bed placements and complete MDS documentation as required
✔ Assist with referrals, prior authorizations, Home Health, SNF, acute rehab, and follow-up appointments
✔ Educate physicians and staff on appropriate levels of care, utilization criteria, and documentation requirements
✔ Perform InterQual reviews for all inpatient (IP) and observation (OBS) admissions
Requirements:
Experience in Utilization Review, Case Management, or Swing Bed Coordination preferred
Strong knowledge of Medicare/Medicaid guidelines and payer requirements
Excellent communication and care coordination skills
Ability to collaborate with multidisciplinary healthcare teams
Pay: $2,400.00 - $2,600.00 per week
Experience:
- Case Manager: 5 years (Required)
License/Certification:
- BLS Certification (Required)
- NM (Required)
Work Location: In person
