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

Ochsner Clinic Foundation•New Orleans, LA

About The Position

This role coordinates and facilitates multidisciplinary care throughout a patient’s hospitalization, reviewing the appropriate use of resources while respecting the patient’s right to self-determination. The Case Manager reviews hospitalizations, recommends a level of care that meets medical-necessity criteria, and confirms that the medical record contains a clear, specific level-of-care order and appropriate documentation. The role may involve discussing alternative care options with Emergency Department or attending physicians. The Case Manager serves as a liaison among patients, caregivers, multidisciplinary team members, post-acute providers, and third-party payers. In collaboration with the care team, the position develops and implements discharge plans tailored to individual patient needs and oversees functional and financial outcomes during acute-care hospitalization. The role performs utilization reviews under applicable guidelines and hospital policy, maintains knowledge of relevant participation conditions and regulatory requirements, and communicates with physicians and other appropriate parties. Work takes place in a patient-care setting and may involve exposure to blood, body fluids, tissue, communicable diseases, hazardous medications, or hazardous waste. The position requires a flexible schedule, including availability for weekends, holidays, and on-call work.

Requirements

Registered Nurse diploma or equivalent.
At least 3 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 patient-information data entry and retrieval.
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 throughout the patient-care process.
Strong interpersonal skills.

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 as directed under CMS guidelines, commercial payer guidelines, and/or hospital policy.
Review patient hospitalizations, recommend a medically necessary level of care, and confirm clear level-of-care orders and other appropriate medical-record documentation.
Discuss alternative care options with Emergency Department or attending physicians when appropriate.
Maintain open communication and function as a liaison among Emergency Department physicians, hospitalists, attending physicians, Physician Advisors, patients, caregivers, multidisciplinary team members, post-acute providers, and third-party payers.
Collaborate with the care team to develop and implement discharge plans based on each patient’s individualized needs.
Oversee and manage functional and financial outcomes, including coordination and implementation of the discharge plan, during acute-care hospitalization.
Maintain knowledge of Conditions of Participation related to utilization review and discharge planning.
Adapt communication and behavior to the patient population, including respecting privacy, introducing oneself appropriately, explaining services or procedures, requesting permissions, and adjusting communication style.
Support Service Excellence, Teamwork, and Integrity; maintain licensure standards and pursue personal and professional development.
Remain knowledgeable about applicable federal, state, and local laws, accreditation standards, and regulatory requirements, and ensure compliance.
Report known or suspected unethical or questionable conduct and patient or employee safety, privacy, or other compliance concerns.
Perform other related duties as required.