Case Manager RN

Morehouse General Hospital; Bastrop (LA); On-site; USD 34,000 - 61,000; Part time

Job summary

Morehouse General Hospital is seeking an RN Case Manager to oversee disease management resources, utilization review, and interdisciplinary coordination. You will collaborate with physicians, manage discharge planning, and help ensure clinical and financial outcomes align with InterQual criteria.

The role emphasizes resource utilization, medical necessity, and care continuum. Strong communication, organization, and payor liaison skills are essential in a fast-paced hospital setting.

Qualifications

• Louisiana RN/LPN license required.
• Minimum two years related experience required.
• Current human resources and/or compensation credentials or certification preferred.
• Prolonged desk work; must be able to ambulate to patient rooms.

Responsibilities

• Focus on resource management to control costs.
• Ensure medical necessity and clinical/discharge management.
• Coordinate services for appropriate patient outcomes from admission to discharge.
• Participate in discharge planning and payer communications.

Skills

Verbal communication

Written communication

Interpersonal skills

Customer service

Microsoft Office

Analytical skills

Problem-solving

Time management

Attention to detail

Education

Louisiana RN/LPN license

Tools

InterQual criteria

Job description

• Location 323 W WALNUT AVE,BASTROP, LA, 71220-4521,United States
• Base Pay $25.00 - $44.07 / Hour
• Employee Type PT Non-Exempt

Description

JOB SUMMARY:
The RN Case Manager will focus on managing resources used for disease
management based on clinical Outcomes, patient needs, and payor requirements.
Elements include utilization review, interdisciplinary care coordination, discharge
planning, case management and data driven clinical and financial outcome
management. Case Management collaborates will work closely with physicians in
order to provide holistic care.

SUPERVISORY RESPONSIBILITIES:
Case Management will delegate to the Social Worker all cases that need of this type of
service.

DUTIES AND RESPONSIBILITY

Focuses on resource management as a way to control costs more effectively managing
resource utilization.
Focuses on medical necessity and the process of managing identified diseases from a
clinical and discharge management perspective.
Focuses on patient's health along a continuum of care and assesses systems of care to
support to the patient.
Review treatment plans against pre-established criteria (INTERQUAL).
Coordinates services that are needed to facilitate appropriate Outcomes from admission
through discharge.
Participates in case management/discharge planning meeting Monday - Friday.
Assists in education Of physicians and caregivers on payor requirements, resource
management and facilitation throughout the medical stay.
Coordinates the appropriate services at the appropriate levels and accesses the appropriate
levels Of care at the appropriate times.

Is responsible for inpatient admission review and continued stay review daily for medical
necessity utilizing Interqual criteria.
Manages cases that are clinically complex which results in high utilization of resources.
Monitor indicators related to resource consumption and resource needs.
Assists in integrating case management activities into multidisciplinary care teams.
Facilitates communication between the physician and the payor and between the hospital and
the payor.
Understands the course of care for specific diagnosis and illness.
Confers with the medical and nursing personnel and other professional staff to determine
legitimacy of treatment and length of stay.
Identifies a working DRG at admission and communicate information regarding patient length Of
Collaborates with the patient and the physician to begin discharge planning on admission.
Collects data for metrics: length of stay, avoidable days, denials, outcome on readmissions,
observation patients, one day stays and swing bed.
Establishes a working relationship with physicians and families including a development Of
mutually developed clinical outcomes.

REQUIRED SKILLS AND ABILITIES:

Excellent verbal and written communication skills.
Excellent interpersonal and customer service skills.
Excellent Sales and customer service Skills.
Excellent organizational skills and attention to detail.
Excellent time management Skills with a proven ability to meet deadlines.
Strong analytical and problem-solving skills.
Ability to prioritize tasks and to delegate them when appropriate.
Ability to function we/l in a high-paced and at times stressful environment.
Proficient with Microsoft Office Suite or related software.

EDUCATION AND EXPERIENCE:
Current Louisiana RN/LPN License

At least two years related experience required.
Current human resources and/or compensation credentials or certification preferred.

PHYSICAL REQUIREMENTS:

Prolonged periods of sitting at a desk and working on a computer.
Must be able to ambulate to patient's room.

SAFETY PRACTICES:
Consistently follows all established Safety procedures, incident/accident protocol and
precautions or universal precautions when performing duties relating to work area.
Follows good infection control practices at all times and is familiar with Infection
control policies, procedures PPE guidelines and guidance relevant to area of work.
Practices proper body mechanics and ergonomics at all times.
Follows established plans, policies and procedures during emergencies, such as fire
evacuation, fire drills and actively participates in emergency exercises/disasters etc.
Reports all Life Safety maintenance issues, defective equipment, etc. through the
Environmental Services work Order system.