RN Utilization Manager - OLGMC - full time

Ochsner Health • Lafayette, LA

1d • Remote

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 is a Registered Nurse who is able to determine the psychosocial, environmental, family economic dynamics that may affect the patient. This job confirms a clear, specific care setting order by the physician and applies hospital approved medical necessity criteria to review appropriate admissions, levels of care and continued stay. Documents completed reviews in the hospital approved data set and discusses, when appropriate, alternative care options with the ED, Admitting or Attending Physician. Functions as the liaison and communicator with the patient, caregivers, multi-disciplinary team members as well as post-acute care and third party payers. 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. The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time. 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. The employer 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. Physical and Environmental Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

• Registered Nurse Diploma or equivalent
• 1 year of Hospital based experience in the delivery of patient care.
• Experience functioning independently and working well within a team setting.
• Experience responding to change positively and working calmly as well as efficiently in high pressure situations.
• Current RN License in the state of practice.
• 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 throughout the patient care process.
• Excellent conflict resolution skills
• Ability to respond to change positively and work calmly, as well as efficiently in high pressure situations.
• Ability to function independently and work well within a team setting.
• Sense of objectivity, strong ethical principles, professionalism, sense of humor, strong work ethic, energy, and creativity
• Must be able to stoop, bend, reach and grab with arms and hands, manual dexterity.
• Must be able to sit for prolonged periods of time.
• Must be able to work a flexible schedule.

Nice To Haves

• Experience in Case Management or Utilization Review
• Business and Financial Knowledge as well as understanding of Health Care Delivery Systems

Responsibilities

• Performs Pre-Admission, Admission and Continued Stay activities
• Maintains open communication with all appropriate parties.
• Manages aspects of the planning process in anticipation of the patient’s movement through the healthcare system.
• Proactively interacts with managed care/ third party payers to obtain financial certification, to appropriate reimbursement and minimize reimbursement denials.
• Manages the care of assigned patients through the healthcare system based on the patient’s individual needs.
• Additional duties as assigned.
• Other related duties as required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 11-50 employees