Job Title: UMCM Coordinator

Location: Remote – Albuquerque, NM (This is a remote position based in Albuquerque, NM, but candidates must reside in Albuquerque as occasional in-office meetings may be required.)

Contract Duration: 1 Year

Job Description:

We are seeking a skilled and motivated UMCM Coordinator to join our team on a 1-year remote contract. This role is responsible for conducting concurrent reviews, coordinating discharge planning, and supporting case management activities. The ideal candidate will work collaboratively with providers, members, and internal teams to assess, plan, and implement care solutions that align with clinical criteria and member benefit plans.

Key Responsibilities:

• Perform concurrent review of medical services based on accepted department criteria.
• Coordinate discharge planning and identify appropriate alternative treatment programs.
• Conduct episodic case management and collaborate with providers and members to ensure appropriate care.
• Assess member needs and implement effective care plans within benefit guidelines.
• Utilize multiple software tools for documentation and communication.
• Engage with ancillary services such as home health care, SNFs, and hospice as needed.

Required Qualifications:

• Active, unrestricted Registered Nurse (RN) license in the state of operation (or reciprocity).
• Minimum of 3 years clinical experience.
• Proficient in using various software systems and tools.
• Strong communication skills (written and verbal).
• Solid analytical skills and attention to detail.
• Willingness to obtain and maintain multi-state RN licenses, if required (fees covered by client).

Preferred Qualifications:

• Knowledge of Utilization Management (UM) and Case Management (CM) processes.
• Familiarity with standardized clinical criteria and ancillary services.
• Prior experience working with Microsoft Teams for virtual training and collaboration.