RN Admissions Case Manager (UM)- Concurrent and ED- OLGMC- PRN- Remote

Ochsner Health; Lafayette (LA); Remote; USD 70,000 - 100,000; Full time

Job summary

Ochsner Health in Louisiana seeks a skilled Registered Nurse to assess psychosocial, environmental, and family dynamics affecting patient care. You will review admissions per physician orders, apply criteria, and discuss care options with the ED, Admitting, or Attending provider.

You will coordinate with the patient, families, and the care team to ensure appropriate next steps. Strong communication, teamwork, and data-entry skills are essential.

Qualifications

• Must be an RN with valid license in the state of practice.
• 1 year of hospital-based patient care experience preferred.
• Strong communication and teamwork abilities required.

Responsibilities

• Performs Pre-Admission, Admission and Continued Stay activities.
• Maintains open communication with patients, families and care teams.
• Reviews, documents and discusses care options with physicians and payers as needed.
• Coordinates patient movement through the healthcare system and ensures appropriate reimbursement.
• Complies with regulatory standards and hospital policies.

Skills

Teamwork

Documentation

Communication

Adaptability

Computer skills

Education

Registered Nurse Diploma

RN License

Job description

Exceptional care starts with exceptional people.

For us, this is more than a job– it’s a calling. It’s waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you to discover your passion, reach your potential, and Pursue Your Purpose. Exceptional care starts with exceptional people and teams. Together we are leading the way.

This job is a registered Nurse who is able to determine the psychosocial, environmental, family economic dynamics that may affect the patient. This job confirms a clear, specific care setting order by the physician and applies hospital approved medical necessity criteria to review appropriate admissions, levels of care and continued stay. Documents completed reviews in the hospital approved data set and discusses, when appropriate, alternative care options with the ED, Admitting or Attending Physician. Functions as the liaison and communicator with the patient, caregivers, multi-disciplinary team members as well as post-acute care and third party payers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.

Education

Required -Registered Nurse Diploma or equivalent

Work Experience

Required -1 year ofHospital based experience in the delivery of patient care.

Experience functioning independently and working well within a team setting. Experience responding to change positively and working calmly as well as efficiently in high pressure situations.

Preferred- Experience in Case Management or Utilization Review Business and Financial Knowledge as well as understanding of Health Care Delivery Systems

Certifications

Required-Current RN License in the state of practice.

Knowledge Skills and Abilities (KSAs)

• Must have computer skills and dexterity required for data entry and retrieval of patient information.
• Must be proficient with Windows-style applications and keyboard.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
• Excellent conflict resolution skills
• Ability to respond to change positively and work calmly, as well as efficiently in high pressure situations.
• Ability to functionindependently and work well within a team setting.
• Sense of objectivity, strong ethical principles, professionalism, sense of humor, strong work ethic, energy, and creativity

Job Duties

• Supports the values of Service Excellence, Teamwork and Integrity. Maintains minimum standards for licensure and strives for professional /personal development.
• Performs Pre-Admission, Admission and Continued Stay activities
• Maintains open communication with all appropriate parties.
• Manages aspects of the planning process in anticipation of the patient’s movement through the healthcare system.
• Proactively interacts with managed care/ third party payers to obtain financial certification, to appropriate reimbursement and minimize reimbursement denials.
• Manages the care of assigned patients through the healthcare system based on the patient’s individual needs.
• Additional duties as assigned.

Other related duties as required. The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time. Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.

The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible. Mechanical lifting devices (carts, dollies, etc.) or team lifts should be utilized. Must be able to stoop, bend, reach and grab with arms and hands, manual dexterity. Must be able to sit for prolonged periods of time. Must be able to work a flexible schedule (e.g. 24/7, weekend, holiday, on call availability). Duties performed may require exposure to blood, body fluid and tissue. The incumbent works in a patient care area; works in an area where patients enter; works directly with patients; and/or works with specimens that could contain diseases. There may be an occupational risk for exposure to all communicable diseases. Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Ochsner is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to any legally protected class, including protected veterans and individuals with disabilities.