Resource Utilization Group Auditor III – Skilled Nursing Facility, SNF
EXL
Registered Nurse Case Manager
Giving Home Healthcare
full-time
Posted on:
Location Type: Office
Location: Albuquerque • New Mexico • 🇺🇸 United States
Visit company websiteSalary
💰 $80,000 - $100,000 per year
Job Level
Mid-LevelSenior
About the role
- Provide clinical oversight and case management for patient care teams
- Review Plans of Care (POCs), Letters of Medical Necessity (LMNs), and clinical documentation for accuracy and compliance
- Review and sign monthly Case Management (CM) notes and perform regular spot checks of nurse charting
- Complete supervisory visits and T1001 for patients without an assigned nurse and for patients assigned to an LPN; handle mid-auth increases or 50% of patient census
- Collaborate with Care Team Directors, Director of Nursing (DON), physicians, and interdisciplinary team regarding clinical needs and escalations
- Notify physicians and interdisciplinary team of patient change in condition
- Serve as a clinical resource for Care Team Directors and Patient Coordinators to resolve complex cases
- Support Directors in reviewing nurse and HHA utilization and meet with patients/families regarding utilization of care plan; participate in escalations requiring clinical involvement
- Office-based with travel to patient homes as needed; attend team meetings, case conferences, and urgent patient visits as required
Requirements
- Active Registered Nurse (RN) license in the state of practice (BSN preferred)
- 3+ years nursing experience; home health, case management, or clinical leadership experience strongly preferred
- Knowledge of DOL/EEOICPA guidelines and home health regulations a plus
- Strong organizational and critical thinking skills
- Ability to provide mentorship and clinical education to interdisciplinary staff
- Proficient in EMR systems; experience with IGEA preferred
Benefits
- Health, Dental, and Vision Insurance
- 401(k) with company matching program
- PTO, holidays, and your birthday off
- Company holidays, floating holiday, and birthday holiday
- Vacation (PTO) and Sick Days
- Company-paid STD and LTD
- Tuition reimbursement program
- $100 monthly cell phone reimbursement
- Monthly in-office lunch for birthdays, anniversaries, and events
- Competitive benefits and compensation; tools and opportunities for career growth
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
case managementclinical oversightnursing experienceclinical documentation reviewsupervisory visitspatient care plansmentorshipclinical educationEMR systemshome health regulations
Soft skills
organizational skillscritical thinkingcollaborationcommunicationproblem-solving
Certifications
Registered Nurse (RN) licenseBSN
