RN Outpatient Care Manager - Covington-FT

Ochsner Clinic Foundation • Covington, KY

1d • Onsite

About The Position

The Manager manages complex/catastrophic patients assigned to Ochsner Network Primary Care Physicians. Utilizes the Case Management process to assess the health care needs of the enrollee, develop a comprehensive treatment plan complete with specific goals and objectives, implement a treatment plan in collaboration with the PCP team and the other providers involved in the patient's care, negotiate and coordinate services for the patient, monitor and evaluate the effectiveness of the plan in achieving the goals and objectives, and change and modify the plan as needs and situations change. This job is embedded within the Primary Care Practice and participates as a key team member in the Patient Centered Medical Home. Assumes responsibility for coordinating care among multiple healthcare providers, the patient's caregiver(s), community services, payors, and others involved in the care of the patient to ensure services are provided seamlessly throughout the continuum of care. Arranges and coordinates resources necessary to manage the patient's disease processes in the home environment and at alternate levels of care (SNF/LTAC/Rehab/Custodial Nursing Home) throughout the care continuum and adheres to the CMSA Standards of Practice for Case Management.

Requirements

• Associates degree
• Registered Nurse in the state of Louisiana
• Certification as a Case Manager (CCM) required within 2 years of hire
• Three years experience in managed care, utilization or quality management, regulatory compliance, medical management or other related MCO departments/functions with BSN
• Must have computer skills and dexterity required for data entry and retrieval of patient information.
• Must be proficient with Windows-style applications and keyboard.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals.
• Excellent knowledge of managed care, CMS, Medicaid and other regulatory standards/requirements.
• Knowledge and experience in using, community resources and other resources to facilitate the patient's care throughout the care continuum.
• Good organizational skills
• Strong written and verbal communication skills
• Strong time management skills and self directed
• Demonstrates Good Judgement

Nice To Haves

• Bachelor's degree in Nursing, additional degrees, business training experience and/or certifications may be combined to meet minimum qualifications.
• 6 years experience in managed care, utilization or quality management, regulatory compliance, medical management or other related MCO departments/functions with certification as a CCM.
• Experience with data capture in a Care Management software system, such as CaseTrakker, CCMS, Amisys, and Facets.
• Experience with Microsoft Office software tools.

Responsibilities

• Identifies patients with complex or catastrophic conditions who are at high risk and collaborates with members at the health care team, the patient and the patient's caregiver(s) to implement a coordinated treatment plan across the continuum.
• Utilizes the case management process to develop comprehensive cost-effective plans at care for patients in care management.
• Collaborates with the multidisciplinary team, PCP and other appropriate care providers to facilitate appropriate care and treatment of the patient.
• Coordinates referrals and appointments with members of the care team and accompanies the patient as needed to appointments.
• Provides education and community resources to members, families and/or caregivers to avoid or reduce hospital admissions through telephonic and face-to-face contact.
• Transitions the patient to the Health Coach or other appropriate team member when discharge from formal case management is appropriate.
• Identifies quality issues that may adversely affect patient outcomes and submit to quality department.
• Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.
• Complies with the Ochsner Health System Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.

Benefits

• Ochsner is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree