LPN Case Manager - Monroe - PRN

Ochsner Health • Monroe, LA

4d • Onsite

About The Position

This job coordinates, negotiates, procures and manages the care of complex patients to facilitate achievement of quality and cost outcomes for admission to the facility, diagnostic procedures, or clinical specialties. Serves as a resource for physician and multi-disciplinary team members to obtain information regarding current charges, reimbursement and payor source limitations. 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.

Requirements

• Graduate of an accredited licensed practical nurse (LPN) program.
• 3 years of hospital-based experience.
• Current licensed practical nurse (LPN) license in the state of practice.
• Working knowledge of admission criteria including, International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes and Medical Necessity guidelines.
• Computer skills and dexterity for data entry and retrieval of information.
• Effective verbal and written communication skills and ability to present information clearly and professionally.
• Proficient with Windows-style applications, various software packages specific to role and keyboard.

Nice To Haves

• Experience in utilization review.

Responsibilities

• Performs pre-admission, admission, and continued stay reviews as directed per content management system (CMS) or commercial payer guidelines and/or hospital policy.
• Collaborates with hospital staff, as required, for authorization/certification processes.
• Explores strategies to reduce length of stay and resource consumption for case managed patient populations.
• Identifies appropriate patients for the various third-party payor pre-certification or pre-authorization process.
• Adapts behavior to the specific patient population, including but not limited to respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.
• Performs other related duties as required.
• 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.

Benefits

• 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.

What This Job Offers

• Career Level: Mid Level
• Education Level: Associate degree