RN Admissions Case Manager (UM Remote)- OLGMC Case Management- Full Time Nights

Ochsner Health•Lafayette, LA

1d•Remote

About The Position

This position determines the psychosocial, environmental, and family economic dynamics that may affect the patient. Functions as the liaison and communicator with the patient, caregivers, multi-disciplinary team members, and post-acute care and third party payers. Confirms a clear, specific care setting order by the physician and applies hospital approved medical necessity criteria to review appropriate admissions and levels of care. Documents completed reviews in the hospital approved data set. ER coverage for OLGMC.

Requirements

Graduate of an accredited school of nursing.
Current Registered Nurse license in state of practice.
1 year of hospital based experience in the delivery of patient care.
Proficiency in using computers, software, and web-based applications.
Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
Good knowledge of business/finance.
Ability to work a flexible work schedule (e.g. 24/7, weekend, holiday, on call availability) and travel throughout and between facilities.

Nice To Haves

Bachelor’s degree in nursing.
Experience in case management or utilization review.
Commission for Case Manager (CCM), Certified Professional Utilization Review (CPUR), Certified Professional in Utilization Management (CPUM) or Certified Professional in Healthcare Management (CPHM) certification.

Responsibilities

Directs and coordinates all admissions and transfers to, from, and within the hospital while coordinating with parallel processing of Environmental Services (EVS) and transport operations that tie into patient flow.
Facilitates professional relationships between unit leadership, operational coordinators, nursing staff, Regional Referral Center, medical staff, admitting office and interdisciplinary teams to provide patient/room assignment based on patient diagnosis, acuity, MD orders and patient flow.
Manages aspects of the planning process in anticipation of the patient’s movement through the healthcare system.
Interacts with managed care/ third party payers to obtain financial certification for appropriate reimbursement and to minimize reimbursement denials.
Manages the care of assigned patients through the healthcare system based on the patient’s individual needs, serving as a a contact person for the rehabilitation team, internal admissions team, clients and external sources to enhance outcomes.
Educates clients, family members or significant others, referral sources, hospital personnel, external payers, and internal/external case managers as to rehabilitation program benefits and services.
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.
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.
Performs other related duties as required.