RN Case Manager/UR Reviewer

Surgery Partners, Inc•Lubbock, TX

16d•Onsite

About The Position

Lubbock Heart & Surgical Hospital is seeking a dedicated RN Case Manager/Utilization Reviewer to join their Lubbock Heart team. This role is crucial in ensuring appropriate patient care levels and effective discharge planning. The hospital emphasizes a positive work environment, teamwork, diversity, and values employee contributions, fostering a family atmosphere where many employees have long tenure. As a physician-owned facility specializing in cardiac, orthopedic, nephrology, urology, and general medical patients, they are committed to providing better outcomes for their employees through comprehensive benefits and opportunities for growth.

Requirements

Current Registered Nurse licensure in the State of Texas or MSW
Must deal calmly and effectively with high stress situation.
Two (2) or more years of medical or psychiatric case mangement or utilization experience.
Medical Terminology
Minimum of three years’ experience in an acute care setting.
Knowledge of Texas Medical Foundation Criteria.
Knowledge of Interqual Screening Criteria.

Nice To Haves

Three to Five years’ case management experience in a hospital setting preferred.

Responsibilities

Review medical records concurrently for appropriateness of level of care and discharge planning.
Review medical records concurrently for insurance and managed care reviews.
Review all patient admission data on a concurrent basis within the designated time frames to determine the suitability of the level of care in accordance with Texas Medical Foundation and/or other criteria.
Collaborate with the attending physician if the case does not meet admission or continued stay criteria. Refers unresolved issues and questionable reviews to the Director of Case Management/CDI.
Document all utilization review activity on the appropriate forms.
Develop and maintain an effective working relationship with physicians and staff.
Work with patients and families to identify resources and additional avenues for post-hospital care and support.
Coordinate with nursing to help with discharge teaching.
Work with other agencies to identify placement, transportation, funding, medications, and other protocols as needed in a cost effective manner.
Prepare and maintain essential records and reports.
Assure a sage and therapeutic environment for patients and staff.
Identify and implement actions to improve clinical services.
Organize time and sets priorities to accomplish work load.
Deal with conflict and problematic situations in an open, respectful, and tactful manner.
Support, assist, and adhere to implementation of the organization mission and vision.
Organize use of resources to assure efficient operation.