Registered Nurse (RN) Case Manager - OMC Jeff Hwy - PRN

Ochsner Health•New Orleans, LA

5d•Onsite

About The Position

This role coordinates multidisciplinary communication and facilitates care throughout a patient’s hospitalization. It 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 the medical record contains a clear, specific level-of-care order and other appropriate documentation. The case manager may discuss alternative care options with emergency department or attending physicians, serves as a liaison among patients, caregivers, care teams, post-acute providers, and third-party payers, and collaborates with the care team on individualized discharge plans. The position performs pre-admission, admission, and continued-stay reviews under applicable CMS and commercial payer guidelines or hospital policy. It oversees functional and financial outcomes during acute-care hospitalization, including coordination and implementation of discharge plans, and maintains compliance with applicable laws, accreditation standards, and regulatory requirements. The position is PRN at OMC Jefferson Highway. It involves patient-care settings and routine exposure to blood, body fluids, tissue, communicable diseases, and potentially hazardous medications or waste. The physical demand classification is Medium Work.

Requirements

Registered nurse diploma or equivalent.
Current registered nurse license in the state of practice.
Basic Life Support (BLS) certification from the American Heart Association.
Proficiency with computers, software, and web-based applications.
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 work a flexible schedule, potentially including 24/7 availability, weekends, holidays, and on-call availability.

Nice To Haves

Bachelor’s degree in nursing.
Three years of hospital-based 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 hospitalizations, recommend medically necessary levels of care, and confirm clear level-of-care orders and appropriate medical-record documentation.
Communicate 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.
Discuss alternative care options with emergency department or attending physicians when appropriate.
Lead oversight and management of functional and financial outcomes during acute-care hospitalization, including coordination and implementation of discharge plans.
Collaborate with the care team to develop and implement discharge plans based on individual patient needs.
Maintain knowledge of conditions of participation related to utilization review and discharge planning, and of applicable laws, accreditation standards, and regulatory requirements.
Adapt interactions and explanations to the patient population, including respecting privacy, requesting permissions, and adjusting communication style.
Support service excellence, teamwork, and integrity; maintain licensure standards and pursue personal and professional development.
Perform other related duties as required and report known or suspected unethical conduct, safety concerns, privacy issues, or other compliance-related concerns.