RN Outpatient Case Manager

Ochsner Health•New Orleans, LA

About The Position

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways. At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today! This job manages identified complex/catastrophic patients attributed to the organization and its Network of partner providers. Uses the case management process to assess the healthcare needs of the enrollee, identify barriers to care, 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 patients’ care, negotiate and coordinate service 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 an integral part of the multi-disciplinary care team and as such coordinated 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. This job adheres to the CMSA Standards of Practice for Care Management. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties. This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.

Requirements

Graduate of an accredited school of nursing.
3 years of experience in a clinical setting
experience documenting in an electronic medical record and using Microsoft Office
experience working in a multi-disciplinary team environment.
Current Registered Nurse (RN) License in the state of practice.
Proficiency in using computers, software, and web-based applications.
Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals.
Excellent knowledge of managed care, CMS, Medicaid and other regulatory standards/requirements and ability to use community resources and other resources to facilitate the patient's care throughout the care continuum.
Good organizational and time management skills and ability to be self-directed and demonstrate good judgement.

Nice To Haves

Bachelor’s degree in nursing.
Experience in case management, care coordination or disease management.
Certification as a Case Manager (CCM).

Responsibilities

Collaborates with members of the health care team, the patient, and patient’s caregiver(s) to develop and implement a coordinated treatment plan across the continuum
Assesses patient for social determinants of health that may create barriers to care and/or adversely impact the care and treatment plans. Includes SDOH in the care/treatment plan and refers to Social Work or Community Health Worker as appropriate and guided by workflow/process
Uses the case management process to develop comprehensive cost-effective plans of care for patients in care management
Collaborates with the multidisciplinary team, Primary Care Provider, and other appropriate care providers to facilitate appropriate care and treatment of the patient
Coordinates referrals and appointments with members of the care team
Provides in-depth disease-based patient education and formulates collaborative action plans with patient/caregiver to achieve agreed-upon goals for self-management and to improve patient health status
Provides community resources to patient, families and/or caregivers to avoid or reduce hospital admission through telephonic and face-to-face contact
Identifies quality issues that may adversely affect patient outcomes and submit to department leadership
Performs other related duties as required
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.
This employer maintains and complies with its 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.