RN Case Manager
Company: Surgery Partners
Location: Lubbock
Posted on: January 24, 2023
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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 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
* 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
LICENSURE AND CERTIFICATION
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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