RN Admissions Case Manager – Concurrent and ED
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Job Description
Part-time remote RN case manager reviewing admissions, continued stays, and medical necessity for Ochsner Health. Coordinating patient care, payers, physicians, and post-acute providers.
Responsibilities:
- Determine psychosocial, environmental, family, and economic dynamics affecting patients
- Confirm physician-ordered care settings and apply hospital-approved medical-necessity criteria
- Review admissions, levels of care, and continued stays
- Document completed reviews in the hospital-approved data set
- Discuss alternative care options with ED, admitting, and attending physicians
- Serve as liaison and communicator among 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 patient movement through the healthcare system
- Interact with managed-care and third-party payers to obtain financial certification, support 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 suspected unethical, questionable, safety, privacy, and 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 positively to change and working calmly and efficiently in high-pressure situations
- Business and financial knowledge and understanding of healthcare delivery systems
- Computer skills and dexterity for patient-information data entry and retrieval
- Proficiency with Windows-style applications and keyboard
- Effective verbal and written communication skills
- Excellent conflict resolution skills
- Ability to work a flexible schedule, including 24/7, weekends, holidays, and on-call availability
- Ability to stoop, bend, reach, grab, and sit for prolonged periods
- Ability to work in a patient-care environment with potential exposure to blood, body fluids, tissue, communicable diseases, hazardous medications, and hazardous waste
Benefits:
- Equal opportunity employment and consideration without regard to legally protected characteristics
- Reasonable accommodations for qualified individuals with disabilities
- Accessibility and application accommodation support
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