RN Case Manager: Utilization & Discharge Planning

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 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.