RN Care Manager: Case Management & Care Coordination

North Oaks Health System; Hammond (LA); On-site; USD 70,000 - 90,000; Full time

Job summary

North Oaks Health System seeks an RN Case Manager to collaborate with patients, nurses, social workers, physicians, and families to optimize care and resource use. The role emphasizes discharge planning, care coordination, and adherence to standards of practice in case management.

The position requires a nursing license in Louisiana, 3+ years of clinical nursing/case management, and strong knowledge of reimbursement and regulatory guidelines. Full-time, days, onsite in Hammond, LA.

Qualifications

• Minimum three years of clinical nursing, case management and/or utilization review experience.
• Emergency services and/or utilization review/case management experience preferred.
• Knowledge of established medical necessity criteria and their application preferred.
• Knowledge of Medicare, Medicaid, Managed Care Organizations, discharge planning, community resources, and referral agencies strongly preferred.
• Knowledge of ICD-10 coding, Case Mix Index monitoring, and legal compliance, and clinical documentation preferred.
• Knowledge of Peer Review and payer functions preferred.
• Knowledge of third party payor appeal process preferred.
• Knowledge of Quality Improvement activities/Team Leader/Facilitator training preferred.

Responsibilities

• Contributes to the development of a goal-directed, age-appropriate plan of care through an interdisciplinary team process.
• Assesses patients’ biophysical, psychosocial, environmental, economic/financial, and discharge planning needs to develop patient-centered goals.
• If needed, procures services and resources, serving as an advocate for patients and families.
• Communicates patient needs and follows up with appropriate professionals (i.e., Social Worker, clinical pharmacist, diabetes educator, and dietician).
• Assesses the appropriateness and timeliness of the level of care, diagnostic testing, clinical procedures, quality and clinical risk issues, and documentation completeness.
• Communicates continually with physicians, patients, caregivers, and care team members to facilitate coordination of clinical activities.
• Seeks information and resources for use in problem solving for complex discharge planning and utilization issues.
• Reviews physician orders to ensure appropriate level of care orders are in the medical record.

Skills

RN Case Management

Utilization Review

Discharge Planning

Interdisciplinary Collaboration

Regulatory Knowledge

Medicare/Medicaid Knowledge

Documentation in EMR

Education

RN program graduate

Job description

North Oaks Health System seeks an RN Case Manager to collaborate with patients, nurses, social workers, physicians, and families to optimize care and resource use. The role emphasizes discharge planning, care coordination, and adherence to standards of practice in case management.

The position requires a nursing license in Louisiana, 3+ years of clinical nursing/case management, and strong knowledge of reimbursement and regulatory guidelines. Full-time, days, onsite in Hammond, LA.