Job Description

Job Summary 

The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities under the supervision of a Registered Nurse or physician. This role involves reviewing medical records for appropriateness and necessity, collaborating with interdisciplinary teams, and facilitating safe and timely transitions of care in compliance with federal, state, and accreditation standards. 

Essential Functions

Conducts daily reviews of medical records to assess the appropriateness, medical necessity, and utilization of hospital services, escalating cases as needed to the Physician Advisor or Utilization Management (UM) committee. Identifies avoidable hospital days and communicates findings effectively to the UM committee and interdisciplinary teams. Coordinates discharge planning activities, including arranging post-hospital placements and collaborating with patients, families, and physicians to ensure continuity of care. Maintains professional relationships with community agencies and resources to facilitate referrals and support patient transitions. Assists in facilitating interdisciplinary meetings, presenting relevant information, and supporting collaborative care planning. Ensures accurate and timely documentation of utilization review, discharge planning activities, and patient interactions in accordance with organizational policies. Identifies and appropriately reports cases to Child/Adult Protective Services as required by legal and ethical guidelines. Participates in the development, implementation, and evaluation of utilization management and discharge planning programs to enhance care delivery and compliance. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

2-4 years of clinical nursing experience required Experience in utilization review, case management, or discharge planning preferred

Knowledge, Skills and Abilities

Strong understanding of utilization management principles, discharge planning, and transitions of care. Knowledge of federal, state, and accreditation standards related to case management and patient care. Excellent communication and interpersonal skills to collaborate with interdisciplinary teams and community resources. Organizational and time management skills to prioritize tasks and meet deadlines in a dynamic environment. Proficiency in electronic medical records (EMR) systems and documentation processes. Ability to assess complex situations, identify solutions, and implement effective care plans.

Licenses and Certifications

LPN - Licensed Practical Nurse - State Licensure required BCLS - Basic Life Support required

State Specific Requirements

New Mexico: Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications preferred.