RN Care Manager - Utilization Review

LCMC Health; Austin (TX); On-site; USD 75,000 - 105,000; Full time

Job summary

LCMC Health's Care Manager role focuses on coordinating patient care plans and ensuring quality across the continuum. You’ll develop individualized plans, perform outbound health assessments, identify barriers, coordinate referrals, and document in EPIC to support seamless transitions.

You are a nurse with active Louisiana license and at least two years of care management experience, working days shift, collaborating with the care team to achieve optimal outcomes and cost-effective care.

Qualifications

• Current nursing license to practice in Louisiana.
• Minimum of 2 years of professional nursing or care management experience.
• WORK SHIFT: Days (United States of America)

Responsibilities

• Develop individualized care plans with goals aligned to patient and caregiver preferences.
• Make outbound calls to assess patient health status.
• Identify gaps or barriers in treatment plans and coordinate care referrals.
• Ensure discharge planning includes necessary services and resources, including medication reconciliation.
• Triage symptom-based calls per approved protocols for diverse patient populations.
• Enroll patients and manage alerts for home monitoring programs.
• Document workflows in EPIC for tracking and quality assessment.
• Educate patients to support self-management of wellness and disease.
• Collaborate with care partners, leadership, and physicians to optimize quality and cost management.
• Demonstrate energy and a passion for quality work.

Skills

Nursing license

Care management

Communication

EPIC

Patient education

Tools

EPIC

Job description

Your job is more than a jobYou overthink every care option and scenario because, as a Care Manager, you’re the hub of your patient's case management and care plan. You assure quality through the continuum of care, collaborate with members of the care team, and implement the plan of care and transition strategies. Achieving the best possible patient outcomes, appropriate length of stay, efficient utilization of resources, coordination of patient, family, and staff communication and education is the center of your nursing universe.You give new meaning to a 9 to 5 schedule because caring doesn’t stop just because you’ve punched a clock and neither does your innovative brain. If it were your loved one, you’d expect nothing less, so you give so much more. Gatekeeper, facilitator and decision-maker, and hand-holder, you apply nursing knowledge, logic, and a little “extra” heart into everything you do. We love that about you.Your experiences, knowledge, skills, empathy, compassion, and your “little something extra” all add up to you. And we’re excited to get to know you and find out what you’ll bring to this case management nursing role.

Your Everyday

• Develop individualized care plans, including prioritized goals, that consider the patient’s and caregivers’ goals, preferences and desired level of involvement in the care management plan.
• Make outbound calls to assess patient’s current health status.
• Identify gaps or barriers in treatment plans.
• Coordinate care for members and makes referrals to outside sources.
• Ensure members discharging from hospital or emergency department receive the necessary services and resources, including medication reconciliation.
• Triage symptom-based calls per approved protocols for a wide range of patients.
• Enroll patients and manage alerts for various home monitoring programs.
• Provide approved general health information and guidance to public caller from approved sources by assessing needs of the caller.
• Document all workflows in EPIC system for purposes of tracking and quality assessment.
• Provide patient education to assist with self-management of wellness and disease.
• Educate enrolled members on chronic and acute disease processes.
• Interact with LCMC Health care partners, leadership and/or physicians to discuss clinical questions, concerns, strategies, and care plans to achieve quality and cost management objectives.
• Demonstrate energy, excitement, and a passion for quality work.

The Must-Haves

• Minimum:Current nursing license to practice in Louisiana and as defined by the Louisiana State Board of Nursing.
• 2 years of professional nursing or care management experience.
• WORK SHIFT:Days (United States of America)

LCMC Health is a community.Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary

Your extras

• Deliver healthcare with heart.
• Give people a reason to smile.
• Put a little love in your work.
• Be honest and real, but with compassion.
• Bring some lagniappe into everything you do.
• Forget one-size-fits-all, think one-of-a-kind care.
• See opportunities, not problems – it’s all about perspective.
• Cheerlead ideas, differences, and each other.
• Love what makes you, you - because we doYou are welcome here.

LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.

The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.