RN Case Manager- Hancock

Ochsner Health•Bay St. Louis, MS

13d

About The Position

The RN Case Manager coordinates multidisciplinary communication and care throughout a patient’s hospitalization while reviewing appropriate resource utilization and respecting the patient’s right to self-determination. The role reviews hospitalizations, recommends a medically necessary level of care, and confirms that a clear, specific level-of-care order and other appropriate documentation are in the medical record. The Case Manager 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. The role collaborates with the care team to develop and implement discharge plans based on each patient’s needs. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m., with occasional weekends and rotating holidays. The position is in a patient-care healthcare setting and routinely involves exposure to blood, body fluids, tissue, communicable diseases, and potentially hazardous medications or waste. The role requires medium physical work, including exerting 20 to 50 pounds of force occasionally, 10 to 25 pounds frequently, and up to 10 pounds constantly to move objects. The employer maintains compliance and privacy standards, requires reporting of suspected misconduct or safety, privacy, and compliance concerns, and is an equal opportunity employer. The job description may be amended and duties may change at the employer’s discretion.

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 weekend, holiday, and on-call availability as applicable.

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 hospital policy.
Review patient hospitalizations, recommend a medically necessary level of care, and confirm the level-of-care order and related documentation in the medical record.
Discuss alternative care options with Emergency Department or attending physicians when appropriate.
Coordinate multidisciplinary communication and facilitate care throughout hospitalization.
Serve as a liaison among patients, caregivers, physicians, multidisciplinary team members, post-acute providers, and third-party payers.
Lead oversight and management of functional and financial outcomes, including coordination and implementation of discharge plans during acute-care hospitalization.
Collaborate with the care team to develop and implement discharge plans tailored to patients’ individual needs.
Maintain open communication with appropriate parties, including Emergency Department physicians, hospitalists, attending physicians, and physician advisors.
Maintain knowledge of conditions of participation related to utilization review and discharge planning.
Adapt communication and service to the patient population, respecting privacy and obtaining permissions as appropriate.
Maintain knowledge of and comply with applicable federal, state, and local laws, accreditation standards, and regulatory requirements.
Support service excellence, teamwork, and integrity; maintain licensure standards and pursue personal and professional development.
Perform other related duties as required.