Utilization Review Nurse- PRN

LCMC Health

19h

About The Position

The Utilization Review Nurse serves as a Care Manager and the hub of a patient's case management and care plan. The role assures quality across the continuum of care, collaborates with the care team, and implements care plans and transition strategies. It focuses on achieving the best possible patient outcomes, appropriate length of stay, efficient use of resources, and coordinated communication and education for patients, families, and staff. The nurse assesses members' health status, identifies gaps and barriers in treatment, coordinates services and referrals, supports transitions from hospitals and emergency departments, and provides symptom triage, health guidance, and patient education. The role also supports home monitoring programs, documents workflows in EPIC, and works with LCMC Health care partners, leadership, and physicians on clinical questions, care strategies, and quality and cost management objectives.

Requirements

Current nursing license to practice in Louisiana, as defined by the Louisiana State Board of Nursing.
At least 2 years of professional nursing or care management experience.

Responsibilities

Develop individualized care plans with prioritized goals that consider patients' and caregivers' goals, preferences, and desired involvement.
Make outbound calls to assess patients' current health status.
Identify gaps or barriers in treatment plans.
Coordinate care for members and make referrals to outside sources.
Ensure members discharged from a hospital or emergency department receive necessary services and resources, including medication reconciliation.
Triage symptom-based calls using approved protocols for a wide range of patients.
Enroll patients in home monitoring programs and manage program alerts.
Provide approved general health information and guidance to public callers by assessing their needs and using approved sources.
Document workflows in the EPIC system for tracking and quality assessment.
Provide patient education to support self-management of wellness and disease.
Educate enrolled members about chronic and acute disease processes.
Interact with LCMC Health care partners, leadership, and/or physicians to discuss clinical questions, concerns, strategies, and care plans in support of quality and cost management objectives.
Demonstrate energy, excitement, and a passion for quality work.