RN Care Manager - Utilization Review

LCMC Health; United States; Remote; USD 65,000 - 85,000; Full time

Benefits offered by this job

Deliver healthcare with heart

Lagniappe in care

One-of-a-kind care

Job summary

LCMC Health in Louisiana is seeking a Care Manager who acts as the hub of patient care plans, coordinating with the care team to ensure quality across the continuum. You will develop personalized plans, assess needs, and guide transitions while documenting in EPIC.

Ideal candidates hold an active Louisiana nursing license, have 2 years of nursing or care management experience, and thrive in a fast-paced, patient-centered environment that values compassion and collaboration.

Qualifications

• Current nursing license to practice in Louisiana (as defined by the Louisiana State Board of Nursing).
• 2 years of professional nursing or care management experience.

Responsibilities

• 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.

Skills

Care management

Nursing license (LA)

Communication skills

Tools

EPIC system

Job description

Your job is more than a job

You 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 do

You 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.

Simple things make the difference.

1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.

2. To ensure quality care and service, we may use information on your application to verify your previous employment and background.

3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.

4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.