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RN Case Manager

Company: Surgery Partners
Location: Lubbock
Posted on: January 24, 2023

Job Description:

DescriptionShift: / Full Time Days with Rotating Call
GENERAL SUMMARY
Registered nurses (RNs) who must have the ability to develop, implement, and evaluate individualized patient care plans. Duties include utilization review, case management, and discharge planning, advocating for patient welfare, and serving as a liaison between patients, their families, and healthcare providers. Reviews medical records concurrently for concurrent discharge planning, length of stay, and insurance and managed care reviews. Works with patients and their families to establish post-hospital care.
ESSENTIAL FUNCTIONS


  • * Reviews medical records concurrently for appropriateness of level of care and discharge planning.
    * Reviews medical records concurrently for insurance and managed care reviews.
    * Reviews 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.
    * Collaborates 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.
    * Documents all utilization review activity on the appropriate forms.
    * Develops and maintains an effective working relationship with physicians and staff.
    * Works with patients and families to identify resources and additional avenues for post-hospital care and support.
    * Coordinates with nursing to help with discharge teaching.
    * Works with other agencies to identify placement, transportation, funding, medications, and other protocols as needed in a cost effective manner.
    * Prepares and maintains essential records and reports.
    * Assures a sage and therapeutic environment for patients and staff.
    * Identifies and implements actions to improve clinical services.
    * Organizes time and sets priorities to accomplish work load.
    * Deals with conflict and problematic situations in an open, respectful, and tactful manner.
    * Supports, assists, and adheres to implementation of the organization mission and vision.
    * Organizes use of resources to assure efficient operation.

    MINIMUM KNOWLEDGE AND SKILLS REQUIRED

    • 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.
      * Know the definitions of fundamental computer terms related to applications software and desktop PC's
      * Know how to open, read, and respond to email
      * Know how to manage electronic files
      * Know how to print electronic documents and reports

      MINIMUM EDUCATION AND EXPERIENCE REQUIRED

      • Graduation from an approved Nursing program, Bachelor Degree in Nursing preferred.

        LICENSURE AND CERTIFICATION

        • Current Registered Nurse licensure in the State of Texas or MSW

          ENVIRONMENTAL AND PHYSICAL REQUIREMENTS
          * Works in temperature controlled environment.
          * Must be able to read, write and speak English fluently, have cognitive skills for math, reading, filing and sterile technique skills. Vision for near, mid-range, far and accommodation. Hearing for low, medium, and high pitch.
          * Communication skills to deal well with employees, patients, families and physicians.
          * Requires physical ability for standing/walking for long hours, sitting, crouching, kneeling, reaching above head and below waist.
          * May be required to move heavy equipment or assist in moving patients.
          * The ability to work with group or team.
          * Must deal calmly and effectively with high stress situation.

          BLOOD-BORNE PATHOGENS:

          * Potential risk of exposure to blood-borne



Keywords: Surgery Partners, Lubbock , RN Case Manager, Executive , Lubbock, Texas

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