RN Case Manager/UR Reviewer

Lubbock Heart & Surgical Hospital; Lubbock (TX); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Flexible Scheduling

No mandatory overtime

Job summary

Lubbock Heart & Surgical Hospital is seeking a dedicated RN Case Manager/Utilization Review to join our team in Lubbock, TX. You will review medical records for appropriateness of care, coordinate with physicians, and assist with discharge planning.

The role requires TX RN licensure (or MSW) and 2+ years of case management, with 3–5 years in a hospital setting preferred. Daytime, full-time hours with no mandatory overtime.

Qualifications

• Current Registered Nurse licensure in the State of Texas or MSW.
• Two or more years of medical or psychiatric case management or utilization experience.
• Three to five years’ case management experience in a hospital setting preferred.
• Minimum of three years’ experience in an acute care setting.
• Knowledge of Texas Medical Foundation Criteria.
• Knowledge of Interqual Screening Criteria.

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.
• 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.

Skills

Medical Terminology

Case management experience

Calm under pressure

Hospital setting experience

Knowledge of criteria

Education

Texas RN licensure or MSW

Job description

Lubbock Heart & Surgical
4810 N Loop 289
Lubbock, TX 79416, USA

Lubbock Heart & Surgical
4810 N Loop 289
Lubbock, TX 79416, USA

Are you looking to be one of the team? To be part of the family and not just another number? Are you looking for a positive work environment where teamwork and diversity are key?

We value your contributions. Every role in our hospital has an impact on each of our patients. We work hard to make sure our employees love their work here. Many have been with us from the very beginning. Because we’re physician-owned, we understand the value of having a well-trained, well-resourced staff. When it comes to procedural healthcare, experience matters.

Lubbock Heart & Surgical Hospital is committed to providing better outcomes for our employees!

• Great Benefits – Medical, Vision, Dental, PTO & 401K
• Individually Tailored 6-12 Week Orientation
• Opportunities for Advancement
• Career Ladder for RNs, LVNs, & CSTs
• Consumer discounts through Perks
• Family Atmosphere
• Opportunity for Multi-Unit Training
• Free CEUs through Cornerstone, our online training system

We are looking for a dedicated RN Case Manager/Utilization Review like you to join our Lubbock Heart team.

What You Will do in this Role:

• 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.

What Qualifications You Will Need:

• 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
• Three to Five years’ case management experience in a hospital setting preferred.
• Minimum of three years’ experience in an acute care setting.
• Knowledge of Texas Medical Foundation Criteria.
• Knowledge of Interqual Screening Criteria.

Your Shift: Full Time Days/Monday-Friday 8am-5pm

LHSH Incentives

• Flexible Scheduling
• No mandatory overtime

Lubbock Heart & Surgical Hospital specializes in the care of cardiac, orthopedic, nephrology, urology, and general medical patients. We are also a highly active inpatient center mainly centered on surgical procedures that include cardiothoracic, orthopedic, urology, and general surgery. We have a 24-hour Emergency Department with 5 fully equipped ED rooms, 4 fully operating OR rooms, 4 cardiac catherization labs with 1 electrophysiology room, 11-day surgery rooms, 58 acute care beds spread over three units, and 16 cardiac critical care rooms. We pride ourselves on giving the best overall care possible to our patients and on our family style atmosphere that includes everyone: patients and their families, physicians, and our employees.

Qualifications

Skills

Behaviors

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Motivations

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Education

Experience

Licenses & Certifications

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.