Case Manager Coordinator at Cibola General Hospital – Grants, New Mexico

The Case Manager Coordinator is a key administrative support role within the Case Management team at our Critical Access Hospital. This position, best suited for a Certified Nursing Assistant (CNA), provides essential coordination, documentation, and authorization support to RN Case Managers.

By handling non-clinical administrative tasks, the Coordinator helps strengthen Medicare compliance, improve Utilization Review (UR) and reimbursement processes, enhance discharge planning efficiency, and reduce the administrative burden on licensed clinical staff. This role supports timely care transitions, minimizes authorization delays and denials, and contributes to better patient throughput and revenue cycle performance.

Key Responsibilities

Care Coordination & Discharge Planning Support

• Provide direct administrative support to RN Case Managers in discharge planning and care coordination activities.
• Assist with advance discharge planning, particularly for orthopedic surgical patients, including timely referrals, equipment orders, and post-acute services.
• Coordinate referrals to community resources and post-acute providers, including:
• Long-Term Care (LTC) facilities
• Home Health Agencies
• Visiting Nurse Services
• Chronic Care Management (CCM) programs
• Meals on Wheels
• Specialty providers
• Community and caregiver support services
• Schedule and confirm follow-up appointments with primary care physicians and specialists.

Medicare & Regulatory Compliance

• Issue and explain required Medicare notices, including the Important Message from Medicare (IMM) and Medicare Outpatient Observation Notice (MOON).
• Ensure timely scanning, uploading, and documentation of notices and related records in the Electronic Health Record (EHR).
• Maintain accurate patient records to support regulatory compliance and audit readiness.

Durable Medical Equipment (DME) Coordination

• Order and coordinate delivery of prescribed DME.
• Track DME arrangements to prevent discharge delays and ensure equipment is available when needed.

Utilization Review & Authorization Support

• Assist RN Case Managers with payer authorization processes, including:
• Initiating authorization requests
• Gathering and compiling clinical documentation
• Submitting or uploading clinical information per payer guidelines
• Tracking authorization status and following up on pending requests
• Communicating updates to the Case Management team
• Maintain an authorization tracking log to monitor timely submission of initial and concurrent clinical reviews.
• Assist in organizing documentation for denial reviews and first- and second-level appeals.
• Support preparation of complete and accurate materials for payer submissions.

Administrative & Documentation Support

• Prepare and transmit clinical documentation required for authorizations and appeals.
• Scan, upload, and maintain all relevant patient documentation in the EHR.
• Communicate effectively and professionally with patients, families, healthcare providers, and payers.
• Perform general clerical and administrative tasks to support the Case Management team.
• Complete other duties as assigned to enhance patient care management and hospital operations.

Scope of Role

The Case Manager Coordinator operates strictly in a support capacity. This role does not include performing clinical assessments, making medical necessity determinations, or conducting Utilization Review. All clinical reviews, level-of-care decisions, and final authorization approvals remain the responsibility of the licensed RN Case Manager.

Required: Active Certified Nursing Assistant (CNA) license in the State of New Mexico. Strong organizational, time management, and multitasking skills. Excellent verbal and written communication and interpersonal skills. Proficiency with computers and document management systems. Preferred: 2–3 years of experience in a hospital setting (case management, discharge planning, or utilization review support preferred). Knowledge of Medicare documentation requirements (IMM, MOON). Experience with authorization processes and payer communication. Familiarity with Cerner EHR system. Work Environment Fast-paced acute care environment in a Critical Access Hospital. Frequent interaction with patients, families, interdisciplinary team members, providers, and external payers. Team-oriented setting with a strong focus on collaboration, compliance, and patient-centered care.