Presbyterian Healthcare Services

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at Presbyterian Healthcare Services

Posted: 8/1/2020
Job Reference #: 15030
Keywords: medical

Job Description

Requisition ID
Case/Utilization Mgmt/Care Coor
Default: Location : City
Location : Name
Rev Hugh Cooper Admin Center
Default: Location : State/Province (Full Name)
New Mexico


Job Description
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: Yes
Work Schedule: Weekday Schedule Monday-Friday

Area:Santa Fe, New Mexico

Participant of the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes.


Assesses members to identify gaps in care and necessary community resource linkages needed to address gaps in care.

Implements, coordinates, and monitors strategies for members and families to improve health and social outcomes.

Develops, documents, and implements a plan which provides appropriate resources to address social, physical, mental, emotional and supportive needs of members that require assistance.

Acts as advocate for members’ care needs by identifying and addressing gaps in care.

Performs ongoing monitoring of the plan of care to evaluate effectiveness.

Maintains professional relationship with internal and external stakeholders, such as inpatient, outpatient and community resources.

Maintains professional relationship with internal and external stakeholders, such as inpatient, outpatient and community resources.

Coordinates the transition of care for plan members by collaborating with Care Coordinators, providers when needed

Advises management of possible trends in inappropriate under and/or over utilization, and other quality of care issues

Support Clinical Operations work with an interdisciplinary team of triage nurses, transition of care nurses, care coordinators, health coaches, medical directors, providers and others

Meets departmental and/or regulatory turnaround times while maintaining productivity and quality standards.

Facilitates a team approach to the coordination and cost-effective delivery to quality care and services

Educates providers, colleagues, members and families regarding the community health worker role and the strategies with a focus on a member-focused approach to care

Utilizes motivational interviewing and other techniques to engage members in services and to foster self-management skills.

Conducts face to face home visits, as required

Assist with development and implementation of the care plan as indicated

Performs other functions as required


High School diploma or equivalent and 2+ years relevant work experience in the healthcare field required; managed care experience preferred. Must have a valid driver license, clean driving record, and able to travel locally. Certification as a Community Health Worker prefered.

Experience in utilization management, quality assurance, home care, community health, long term care, medical assistant or occupational health required. Proficiency in Microsoft Word, Excel and Outlook required. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment. Knowledge of referral coordination to community & private/public resources


Benefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries
  • Full medical, dental and vision insurance
  • Flexible spending accounts (FSAs)
  • Free wellness programs
  • Paid time off (PTO)
  • Retirement plans, including matching employer contributions
  • Continuing education and career development opportunities
  • Life insurance and short/long term disability programs

About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.

Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. </

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Application Instructions

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