New Mexico Licensed LTC Reviewer

Job Summary

New Mexico Licensed LTC Reviewer is a full-time, exempt position responsible for conducting Nursing Facility Level of Care determinations, performing utilization review activities, and ensuring services meet Long Term Care Supports and Services criteria.

Key Responsibilities

• Conduct NF LOC evaluations and determinations, reviewing medical documentation for eligibility
• Document recommendations and determinations in the case management system, including approvals and denials
• Review and approve or deny community benefit care plans according to established criteria and timelines

Required Qualifications

• Active Nursing license in NM or compact license (RN or LPN) with at least one year of relevant experience
• Medical Social Worker or therapist with a minimum of one year of relevant experience
• Preferred experience in MCO or health plan insurance environment with expertise in utilization management
• Knowledge of state and federal regulations regarding patient records confidentiality
• Experience with electronic data entry and documentation