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Utilization Review Registered Nurse (RN) - Case Management - Nights (Remote) job in River Ridge at Ochsner Health

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Utilization Review Registered Nurse (RN) - Case Management - Nights (Remote) at Ochsner Health

Utilization Review Registered Nurse (RN) - Case Management - Nights (Remote)

Ochsner Health River Ridge, LA (Remote) Full-Time
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 determines the psychosocial, environmental, and family economic dynamics that may affect the patient. Functions as the liaison and communicator with the patient, caregivers, multi-disciplinary team members, and post-acute care and third party payers. Confirms a clear, specific care setting order by the physician and applies hospital approved medical necessity criteria to review appropriate admissions and levels of care. Documents completed reviews in the hospital approved data set.

Schedule

Four 12-hour shifts per week (6pm - 6am) fully remote

Education

Required - Registered nurse diploma.

Preferred - Associate's degree in nursing.

Work Experience

Required - 1 year of hospital based experience in the delivery of patient care.

Preferred - Experience in case management or utilization review.

Certifications

Required - Current Registered Nurse license in state of practice.

Preferred - Commission for Case Manager (CCM), Certified Professional Utilization Review (CPUR), Certified Professional in Utilization Management (CPUM) or Certified Professional in Healthcare Management (CPHM) certification.

Knowledge Skills and Abilities (KSAs)
  • 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 throughout the patient care process.
  • Good knowledge of business/finance.
  • Ability to work a flexible work schedule (e.g. 24/7, weekend, holiday, on call availability) and travel throughout and between facilities.


Job Duties
  • Directs and coordinates all admissions and transfers to, from, and within the hospital while coordinating with parallel processing of Environmental Services (EVS) and transport operations that tie into patient flow.
  • Facilitates professional relationships between unit leadership, operational coordinators, nursing staff, Regional Referral Center, medical staff, admitting office and interdisciplinary teams to provide patient/room assignment based on patient diagnosis, acuity, MD orders and patient flow.
  • Manages aspects of the planning process in anticipation of the patient's movement through the healthcare system.
  • Interacts with managed care/ third party payers to obtain financial certification for appropriate reimbursement and to minimize reimbursement denials.
  • Manages the care of assigned patients through the healthcare system based on the patient's individual needs, serving as a a contact person for the rehabilitation team, internal admissions team, clients and external sources to enhance outcomes.
  • Educates clients, family members or significant others, referral sources, hospital personnel, external payers, and internal/external case managers as to rehabilitation program benefits and services.
  • 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.


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.

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 essential functions of this job include (but are not limited to) the following: Frequently exerting 10 to 20 pounds of force to move objects; occasionally exerting up to 100 pounds of force. Physical demand requirements are in excess of those for sedentary work. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Duties performed routinely require exposure to blood, body fluid and tissue.
The incumbent works in a patient care area; works in an area where patients enter; works directly with patients; and/or works with specimens that could contain diseases. There may be an occupational risk for exposure to all communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Individuals who reside in and will work from the state of Colorado are not eligible for remote work position.

Ochsner Health endeavors to make our site accessible to all users. If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at
504-842-4748
(select option 1) or [ Email address blocked ] - Click here to apply to Utilization Review Registered Nurse (RN) - Case Management - Nights (Remote). This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.


EEO is the Law links in English, Spanish, Chinese, and Arabic.

Affirmative Action Policy Statement

Recommended Skills

  • Adaptability
  • Administration
  • Case Management
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  • Communication
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