RN Care Navigator - Utilization Review & Discharge Hero

American Case Management Association, Inc.; New Orleans (LA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

None

Job summary

Ochsner Health is seeking an RN Care Coordinator / Utilization Review Nurse to coordinate patient care across hospitalization, discharge planning, and care transitions.

You will perform admission, continued-stay, and utilization reviews, collaborate with physicians and care teams, and advocate for optimal patient outcomes. Strong knowledge of CMS guidelines and regulatory requirements is essential. This role supports efficient, patient-centered care in a multidisciplinary environment.

Qualifications

• Graduate of an accredited School of Nursing.
• Current Registered Nurse (RN) license in the state of practice.
• Basic Life Support (BLS) certification through the American Heart Association.
• Preferred: Bachelor’s Degree in Nursing (BSN).
• Experience in case management, discharge planning, utilization review, or care coordination is a plus.

Responsibilities

• Conduct admission, continued-stay, and utilization reviews using CMS, payer, and organizational guidelines.
• Collaborate with physicians and care teams to ensure appropriate level-of-care determinations and documentation.
• Coordinate individualized discharge planning and transitions of care.
• Serve as a liaison among patients, families, providers, payers, and post-acute care partners.
• Help optimize patient outcomes, resource utilization, and overall care experience.
• Maintain knowledge of regulatory requirements related to utilization management and discharge planning.
• Promote exceptional patient-centered care and service excellence.

Skills

CMS guidelines

Utilization review

Discharge planning

Care coordination

Interdisciplinary collaboration

Patient advocacy

Documentation

Education

RN license

BLS certification

BSN (preferred)

Job description

Ochsner Health is seeking an RN Care Coordinator / Utilization Review Nurse to coordinate patient care across hospitalization, discharge planning, and care transitions.

You will perform admission, continued-stay, and utilization reviews, collaborate with physicians and care teams, and advocate for optimal patient outcomes. Strong knowledge of CMS guidelines and regulatory requirements is essential. This role supports efficient, patient-centered care in a multidisciplinary environment.