What are the responsibilities and job description for the RN Case Manager position at Ochsner Health?

The Registered Nurse Case Manager handles multi-disciplinary communications and facilitations of care throughout a patient’s hospitalization, which includes a review of the appropriate utilization of resources, balanced with the patient’s right to self-determination. Reviews patient hospitalizations, recommends a level of care that meets medically necessary hospital care criteria, and confirms a clear, specific level of care order and other appropriate documentation in the medical record. May discuss alternative care options with the Emergency Department (ED) physician or attending physician. Works as a liaison and communicates with the patient, caregiver, multi-disciplinary team members as well as post-acute and third-party payers. Collaborates with the care team to develop and implement discharge plans based on patient’s individualized needs.

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.

Education:

Required - Graduate of an accredited school of nursing.
Preferred - Bachelor’s degree in nursing.

Work Experience:

Required - None.
Preferred - 3 years of hospital-based experience in discharge planning, case management or utilization review.

Certifications:

Required - Current registered nurse license in state of practice (RN)
Basic Life Support (BLS) from the American Heart Association.

Preferred - Certification in Case Management (CCM) or Accredited Case Manager (ACM).

Job Duties:

Performs pre-admission, admission, and continued stay reviews as directed per CMS guidelines, commercial payer guidelines, and/or hospital policy.
Supports the values of service excellence, teamwork and integrity and maintains minimum standards for licensure and strives for personal/professional development.
Maintains knowledge of the conditions of participation as it relates to utilization review and discharge planning.
Maintains open communication with all appropriate parties while functioning as a liaison between ED physicians, hospitalists, attending physicians, and physician advisors.
Leads the oversight and management of the functional and financial outcomes, including coordination and implementation of the discharge plan, during the acute-care hospitalization.
Adapts behavior to the specific patient population, including but not limited to respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.
Performs other related duties as required.

About Ochsner Health:

Ochsner Health is a system that delivers health to the people of Louisiana, Mississippi and the Gulf South with a mission to Serve, Heal, Lead, Educate and Innovate. Ochsner Health is a not-for-profit committed to giving back to the communities it serves through preventative screenings, health and wellness resources and partnerships with innovative organizations that share our vision. Ochsner Health healed more than 876,000 people from across the globe in 2019, providing the latest medical breakthroughs and therapies, including digital medicine for chronic conditions and telehealth specialty services. Ochsner Health is a national leader, named the top hospital in Louisiana and a top children’s hospital by U.S. News & World Report. As Louisiana’s leading healthcare educator, Ochsner Health and its partners educate thousands of healthcare professionals annually. Ochsner Health is innovating healthcare by investing in new technologies and research to make world-class care more accessible, affordable, convenient and effective. Ochsner's team of more than 26,000 employees and 4,500 providers are working to reinvent the future of health and wellness in the region. To learn more about Ochsner Health, please visit www.ochsner.org. To transform your health, please visit www.ochsner.org/healthyyou.

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RN Case Manager

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