Remote Registered Nurse (RN) - Utilization Manager - Case Management - PRN

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 with a diverse medical background, 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.

Supports the values of Service Excellence, Teamwork and Integrity. Maintains minimum standards for licensure and strives for professional /personal development. 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.