Utilization Review Case Management Rn Jobs in Lubbock, TX

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 Director of Case Management like you to join our Lubbock Heart team.

What You Will do in this Role:

• Plans, directs, implements and monitors hospital-wide efforts to ensure appropriate level of care and psychosocial interventions while serving as a liaison for the hospital with medical staff, hospital departments and services, regulator and extra review agencies, third party payers, financial services and community health and welfare services.
• Coordinates programs among departments and ensures services according to the appropriateness of care, appropriateness of admissions and continued hospitalizations, monitors length of stay, observation status utilization, delays in discharges or care, case mix index and other reimbursement/financial indicators in order to recommend and implement hospital-wide improvement strategies.
• Performs concurrent reviews for patients to ensure that extended stays are medically justified and documented in patient’s medical records.
• Refers to the Utilization Review Physician Advisor (s) all cases that do not meet established guidelines for admission or continued stay.
• Assists in patient facilitation through participation in daily bed management meetings and implementation of multi-disciplinary activities to improve quality of care.
• Participates in the development of effective hospital-wide Care Management strategies, ensuring compliance with external accrediting agencies and patient care review requirements.
• Ensures compliance regarding resource allocation, discharge planning and social work intervention processes in accordance with regulatory agencies including but not limited to DOH, CMS, etc., and other authority, and acts as a liaison of the same.
• Serves as a change agent for implementation of new programs and existing ones.
• Works independently and provides and coordinates patient care using an interdisciplinary approach encompassing the entire continuum of care which may include outpatient, inpatient and post hospital services.
• Helps to develop and utilizes medical guidelines in an effort to provide high quality, cost effective care sensitive to the resources available.
• Utilizes data to make informed decisions related to the delivery and outcomes of Case Management, department productivity and staffing.
• Assesses needs and plans, communicates and designs services that are appropriate to the hospital mission and patient/family needs.
• Complies monthly reports and statistics to the Utilization Review Committee.
  Integrates and coordinates services using continuous quality improvement tools.
• Maintains a positive work environment for staff and physicians and promotes team efforts.
• Adheres to established departmental operation and salary budgets, and provides explanations of budget variances.
• Ensures performance evaluations are current and are reviewed by employees and completed timely.
• Completes initial departmental orientation and competency review for newly hired employees.
• Ensures that all licensure/credentials certificates for applicable personnel are valid and up to date. Updates and maintains job descriptions for each job classification in accordance with hospital policy and procedures.
  Additional duties as assigned

What Qualifications You Will Need:

• 3 – 5 years’ experience in a hospital setting as a case manager with utilization review experience
• Certification as a Case Manager preferred
• Licensed as an RN in the state of Texas, BCLS.
• BSN preferred
• Prior supervisory experience preferred

Your Shift: Full Time

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.

Lubbock#250

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.