RN Case Manager (Oncology Unit) - PRN

Ochsner Health•New Orleans, LA

11d

About The Position

The RN Case Manager facilitates multidisciplinary communication and coordination of care throughout a patient’s hospitalization, balancing appropriate use of resources with the patient’s right to self-determination. The role reviews hospitalizations, recommends medically necessary levels of care, and confirms that the medical record includes a clear level-of-care order and appropriate documentation. The case manager may discuss alternative care options with emergency department or attending physicians and serves as a liaison among patients, caregivers, multidisciplinary teams, post-acute providers, and third-party payers. The role 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 applicable CMS and commercial payer guidelines or hospital policy. It supports service excellence, teamwork, and integrity; maintains knowledge of regulations governing utilization review and discharge planning; and coordinates discharge planning and functional and financial outcomes during acute-care hospitalization. The case manager adapts communication and care to individual patient populations, maintains compliance with applicable laws and standards, and performs related duties as required. The role is based in a patient-care environment and routinely involves exposure to blood, body fluids, tissue, communicable diseases, and potentially hazardous medications or waste. The position is classified as medium work, involving specified occasional, frequent, and constant force exertion. Reasonable accommodations may be made for qualified individuals with disabilities.

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 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, including 24/7 availability, weekends, holidays, or 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 in accordance with CMS guidelines, commercial payer guidelines, and hospital policy.
Review hospitalizations and recommend an appropriate level of care that meets medically necessary hospital-care criteria.
Confirm clear, specific level-of-care orders and appropriate documentation in the medical record.
Discuss alternative care options with emergency department or attending physicians when appropriate.
Coordinate multidisciplinary communication and serve as a liaison among patients, caregivers, physicians, physician advisors, hospital teams, post-acute providers, and third-party payers.
Collaborate with the care team to develop and implement individualized discharge plans.
Lead oversight and management of functional and financial outcomes, including coordination and implementation of discharge plans during acute-care hospitalization.
Maintain knowledge of conditions of participation and other requirements related to utilization review and discharge planning.
Adapt communication and behavior to the patient population, including respecting privacy, 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 laws, accreditation standards, and regulatory requirements and ensure compliance.
Report known or suspected unethical or questionable conduct and patient or employee safety, privacy, or compliance concerns.
Perform other related duties as required.