RN or LCSW Case Manager- Case Management- OLGMC- Full Time

Ochsner Health•Lafayette, LA

21h

About The Position

The RN or LCSW Case Manager coordinates multidisciplinary communication and care throughout a patient's hospitalization, reviewing resource use while respecting the patient's right to self-determination. The role reviews hospitalizations, recommends a medically necessary level of care, and confirms that the medical record contains a clear level-of-care order and appropriate documentation. The case manager may discuss alternative care options with Emergency Department or attending physicians and acts as a liaison among patients, caregivers, care-team members, post-acute providers, and third-party payers. In collaboration with the care team, the role develops and implements discharge plans based on each patient's individual needs. The case manager performs pre-admission, admission, and continued-stay reviews under applicable CMS and commercial payer guidelines or hospital policy; supports service excellence, teamwork, and integrity; and maintains knowledge of regulatory requirements for utilization review and discharge planning. The role coordinates discharge planning and oversees functional and financial outcomes during acute-care hospitalization. It also requires adapting communication and care processes to the needs of specific patient populations, maintaining professional and licensure standards, and complying with applicable laws, accreditation standards, and the employer's compliance and privacy requirements.

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 the ability to present information clearly and professionally to people at varying levels.
Strong interpersonal skills.
Ability to work a flexible schedule, such as 24/7 coverage, 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 in accordance with CMS guidelines, commercial payer guidelines, and hospital policy.
Review patient hospitalizations, recommend an appropriate medically necessary level of care, and confirm clear level-of-care orders and supporting documentation in the medical record.
Coordinate multidisciplinary communication and facilitate care throughout the patient's hospitalization.
Communicate and function as a liaison among Emergency Department physicians, hospitalists, attending physicians, physician advisors, patients, caregivers, care-team members, post-acute providers, and third-party payers.
Discuss alternative care options with Emergency Department or attending physicians when appropriate.
Collaborate with the care team to develop and implement individualized discharge plans.
Oversee and manage functional and financial outcomes, including coordination and implementation of the discharge plan during acute-care hospitalization.
Maintain knowledge of conditions of participation and applicable requirements related to utilization review and discharge planning.
Adapt behavior and communication to the needs of the patient population, including respecting privacy, introducing oneself appropriately, explaining services or procedures, requesting permissions, and adjusting communication style.
Maintain compliance with applicable laws, regulations, accreditation standards, and employer compliance and privacy requirements.
Support service excellence, teamwork, and integrity; maintain licensure standards; and pursue personal and professional development.
Perform other related duties as required.