RN Utilization Manager – OLG Case Management

🔥 3 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟢 Junior

👔 Manager

👻 Ghost score 10%

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Ochsner Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1942

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

💰 Grant on 2023-07

Healthcare • Healthcare Insurance • Non-profit

Ochsner Health is a comprehensive healthcare system dedicated to delivering health services to the people of Louisiana, Mississippi, and the Gulf South. Its mission is to serve, heal, lead, educate, and innovate in healthcare. As the largest academic medical center in Louisiana, Ochsner focuses on a clinically-integrated research program aimed at improving community wellness and educating future healthcare leaders. They offer a variety of services, including primary care, urgent care, women's and men's health, digital medicine, and specialized treatments such as cancer care, heart and vascular services, transplants, and more. Ochsner also emphasizes community engagement through partnerships, education, and outreach programs, while fostering an inclusive environment. They are committed to accessibility, patient stories, and transparency in billing and insurance information. Ochsner is a non-profit organization and an equal opportunity employer.

📋 Description

• Determine psychosocial, environmental, family, and economic dynamics affecting patients • Confirm physician-specific care setting orders and apply hospital-approved medical necessity criteria • Review appropriate admissions, levels of care, and continued stays • Document completed reviews in the hospital-approved data set • Discuss alternative care options with ED, admitting, or attending physicians when appropriate • Serve as liaison and communicator with patients, caregivers, multidisciplinary teams, post-acute care providers, and third-party payers • Perform pre-admission, admission, and continued-stay activities • Maintain open communication with appropriate parties • Manage planning for patients’ movement through the healthcare system • Interact with managed-care and third-party payers to obtain financial certification, secure appropriate reimbursement, and minimize denials • Manage assigned patients’ care through the healthcare system based on individual needs • Maintain compliance with applicable laws, accreditation standards, and regulatory requirements • Report known or suspected unethical, questionable, safety, privacy, or compliance-related concerns

🎯 Requirements

• Registered Nurse Diploma or equivalent • 1 year of hospital-based experience in the delivery of patient care • Current RN License in the state of practice • Experience functioning independently and working well within a team setting • Experience responding to change positively and working calmly and efficiently in high-pressure situations • Computer skills and dexterity for data entry and retrieval of patient information • Proficiency with Windows-style applications and keyboard • Effective verbal and written communication skills • Excellent conflict resolution skills • Business and financial knowledge and understanding of health care delivery systems • Experience in Case Management or Utilization Review preferred • Ability to work a flexible schedule, including 24/7, weekends, holidays, and on-call availability • Ability to meet light-work physical demands, sit for prolonged periods, and perform stooping, bending, reaching, grabbing, and manual dexterity tasks • Ability to work in healthcare environments with potential exposure to blood, body fluids, communicable diseases, hazardous medications, and hazardous waste

🏖️ Benefits

• Full-time employment • Remote work Monday–Friday, 8:00 AM–4:30 PM