Registered Nurse (RN) - Case Manager - Ochsner Baptist - Full Time

Ochsner Health•New Orleans, LA

About The Position

The Registered Nurse (RN) Case Manager coordinates multidisciplinary communication and facilitation of care throughout a patient’s hospitalization. The role reviews the appropriate use of resources while respecting patients’ right to self-determination; reviews hospitalizations and recommends medically necessary levels of care; and confirms that clear, specific level-of-care orders and appropriate documentation are present in the medical record. The Case Manager may discuss alternative care options with emergency department or attending physicians and serves as a liaison among patients, caregivers, multidisciplinary team members, post-acute providers, and third-party payers. The role collaborates with the care team to develop and implement discharge plans based on each patient’s needs. The position performs pre-admission, admission, and continued-stay reviews in accordance with CMS and commercial payer guidelines and hospital policy. It oversees functional and financial outcomes during acute-care hospitalization, including coordinating and implementing discharge plans. The Case Manager maintains knowledge of applicable participation requirements, laws, accreditation standards, and regulatory requirements, and supports compliance, patient safety, privacy, and the organization’s standards of conduct. The role requires a Registered Nurse diploma or equivalent and a current Louisiana RN license and American Heart Association Basic Life Support certification. A bachelor’s degree in nursing and case management certification are preferred. Three years of hospital-based experience are required. This is a full-time position at Ochsner Baptist. The work is in a patient-care setting and includes routine potential exposure to blood, body fluids, tissue, communicable diseases, and hazardous medications or waste. The position requires the ability to stand for prolonged periods, meet medium physical-work demands, and work a flexible schedule that may include weekends, holidays, 24/7 coverage, or on-call availability.

Requirements

Registered Nurse diploma or equivalent.
Three years of hospital-based experience.
Current State of Louisiana Registered Nurse License.
Basic Life Support (BLS) certification from the American Heart Association.
Computer skills and dexterity for entering and retrieving patient information.
Proficiency with Windows-style applications and keyboard use.
Effective verbal and written communication skills, including the ability to present information clearly and professionally to people at varying levels.
Strong interpersonal skills.
Ability to meet the described medium physical-work demands, including exerting 20 to 50 pounds occasionally, 10 to 25 pounds frequently, and up to 10 pounds constantly to move objects.
Ability to stand for prolonged periods.
Ability to work a flexible schedule, which may include 24/7 coverage, weekends, holidays, or on-call availability.
Ability to work in a patient-care setting with routine potential exposure to blood, body fluids, tissue, communicable diseases, and hazardous medications or waste.

Nice To Haves

Bachelor’s degree in Nursing.
Experience in discharge planning, case management, or utilization review.
Certification in Case Management (CCM) or Accredited Case Manager (ACM).

Responsibilities

Perform pre-admission, admission, and continued-stay reviews according to CMS guidelines, commercial payer guidelines, and hospital policy.
Review patient hospitalizations and recommend a level of care that meets medically necessary hospital-care criteria.
Confirm clear, specific level-of-care orders and other appropriate documentation in the medical record.
Discuss alternative care options with emergency department or attending physicians when appropriate.
Serve as a liaison among patients, caregivers, multidisciplinary team members, post-acute providers, third-party payers, ED physicians, hospitalists, attending physicians, and Physician Advisors.
Collaborate with the care team to develop and implement individualized discharge plans.
Lead oversight and management of functional and financial outcomes, including discharge-plan coordination and implementation during acute-care hospitalization.
Maintain knowledge of Conditions of Participation as they relate to utilization review and discharge planning.
Maintain open communication with appropriate parties throughout the patient-care process.
Adapt communication and approach to the patient population, including respecting privacy, introducing oneself appropriately, explaining services or procedures, requesting permission, and adapting communication style.
Support Service Excellence, Teamwork, and Integrity; maintain licensure standards and pursue personal and professional development.
Remain knowledgeable about applicable laws, accreditation standards, and regulatory requirements, and ensure compliance.
Report known or suspected unethical or questionable conduct and concerns related to patient or employee safety, patient privacy, or compliance.
Perform other related duties as required.