Registered Nurse Case Manager / Utilization Review

Job overview

The Registered Nurse Case Manager / Utilization Review role is onsite in Grants, NM, with compensation not specified. Cibola General Hospital is a critical access hospital serving rural communities with access to medical services closer to home. The nurse coordinates care progression, discharge planning, and utilization review to support safe transitions, appropriate levels of care, regulatory compliance, and efficient resource use. Collaboration with patients, families, providers, payers, and post-acute services also supports patient outcomes and hospital reimbursement integrity.

What you'll do

• Assess patient clinical, psychosocial, financial, and discharge needs
• coordinate care progression, discharge planning, referrals, and post-acute services
• identify discharge barriers and participate in interdisciplinary rounds
• conduct concurrent and retrospective utilization reviews
• determine patient status and obtain authorizations
• submit clinical documentation to payers
• address potential denials and support appeals
• document activities in the EHR
• educate providers and staff on medical necessity and payer requirements.

What we're looking for

Skills & competencies

registered nurse case manager

utilization review

grants nm

cibola general hospital

care coordination

discharge planning

medical necessity review

prior authorization

denial prevention

acute care

rn license

critical access hospital

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical and dental benefits, voluntary vision, 403(b) match, Roth IRA, life and AD&D, FSA, Employee Assistance Program, voluntary long-term disability, PTO, sick leave, holidays, housing or fuel assistance for eligible employees, sign-on and relocation bonuses, retention bonuses, tuition reimbursement, and certification reimbursement.

Why this role

Active unrestricted RN license in New Mexico or a Compact State and 2–3 years of recent acute care experience required. New graduates are welcomed in the hospital's broader nursing program; this role's stated qualifications require acute care experience.

About the employer

Cibola General Hospital is hiring for this role. Industry: General Medical and Surgical Hospitals. Sector: 62.