RN Case Manager- OLG Region Case Management- PRN

Ochsner Health•Lafayette, LA

About The Position

The RN Case Manager handles multidisciplinary communication and facilitation of care throughout a patient’s hospitalization. The role reviews appropriate resource utilization while respecting patient self-determination, evaluates hospitalizations against medically necessary hospital care criteria, and confirms that a clear, specific level-of-care order and appropriate supporting documentation are present in the medical record. The case manager may discuss alternative care options with ED or attending physicians and serves as a liaison among patients, caregivers, multidisciplinary team members, post-acute providers, and third-party payers. The role collaborates with the care team to develop and implement individualized discharge plans and supports case management for the OLG Region. The position performs pre-admission, admission, and continued-stay reviews in accordance with CMS and commercial payer guidelines and hospital policy. It oversees functional and financial outcomes during acute-care hospitalization, including coordinating and implementing discharge plans. The case manager maintains knowledge of relevant participation conditions, laws, accreditation standards, and regulatory requirements, and ensures compliance with applicable requirements. Duties also include adapting communication and care interactions to patient needs, maintaining professional standards, and performing other related duties as required.

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 in using 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 throughout the patient care process.
Strong interpersonal skills.
Ability to work a flexible schedule, including availability for 24/7 coverage, weekends, holidays, and on-call work.

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 hospitalizations and recommend a level of care that meets medically necessary hospital care criteria; confirm a clear, specific level-of-care order and appropriate documentation in the medical record.
Communicate and function as a liaison among 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 during acute-care hospitalization.
Lead oversight and management of functional and financial outcomes during the acute-care hospitalization.
Maintain knowledge of conditions of participation related to utilization review and discharge planning.
Adapt communication and interactions to the needs of the patient population, including respecting privacy, explaining services or procedures, requesting permissions, and adjusting communication style.
Maintain compliance with applicable federal, state, and local laws, accreditation standards, and regulatory agency requirements.
Support service excellence, teamwork, and integrity; maintain licensure standards and pursue personal and professional development.
Perform other related duties as required.