RN Case Manager (Oncology Unit) - PRN

Ochsner Clinic Foundation•New Orleans, LA

About The Position

This role facilitates multidisciplinary communication and coordination of care throughout a patient’s hospitalization, reviewing appropriate resource utilization while respecting patients’ right to self-determination. The RN Case Manager reviews hospitalizations, recommends a level of care that meets medically necessary hospital care criteria, and confirms that the medical record contains a clear, specific level-of-care order and other appropriate documentation. The role 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. It collaborates with the care team to develop and implement discharge plans tailored to each patient’s needs. The position performs pre-admission, admission, and continued-stay reviews under CMS guidelines, commercial payer guidelines, and hospital policy. It oversees functional and financial outcomes during acute-care hospitalization, including coordination and implementation of discharge plans, and maintains knowledge of applicable utilization review and discharge-planning requirements. The role also adapts communication and care approaches to the patient population and complies with applicable laws, accreditation standards, regulations, and the employer’s Compliance & Privacy Program. The job is identified as PRN. It requires a graduate of an accredited nursing school and a current registered nurse license in the state of practice, as well as American Heart Association Basic Life Support certification. Hospital-based discharge planning, case management, or utilization review experience and a bachelor’s degree in nursing are preferred. Work is in a patient-care healthcare environment, with routine exposure to blood, body fluids, tissue, communicable diseases, and possible exposure to hazardous medications or waste. The physical demand classification is Medium Work.

Requirements

Graduate of an accredited school of nursing.
Current registered nurse license in the state of practice.
Basic Life Support (BLS) certification from the American Heart Association.
Proficiency using computers, software, and web-based applications.
Effective verbal and written communication skills, including presenting information clearly and professionally to people at varying levels.
Strong interpersonal skills.
Ability to work a flexible schedule, 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 according to CMS guidelines, commercial payer guidelines, and/or hospital policy.
Review patient hospitalizations, recommend a medically necessary level of care, and confirm the level-of-care order and supporting documentation in the medical record.
Communicate and coordinate with ED physicians, hospitalists, attending physicians, physician advisors, patients, caregivers, multidisciplinary team members, post-acute providers, and third-party payers.
Discuss alternative care options with ED or attending physicians when appropriate.
Coordinate and implement individualized discharge plans in collaboration with the care team.
Oversee functional and financial outcomes during acute-care hospitalization.
Maintain knowledge of conditions of participation related to utilization review and discharge planning.
Adapt communication and interactions to the needs and characteristics of the patient population, including respecting privacy and requesting permissions.
Maintain knowledge of and comply with applicable laws, accreditation standards, regulatory requirements, and compliance and privacy standards.
Support service excellence, teamwork, and integrity; maintain licensure standards and pursue professional development.
Perform other related duties as required.