RN Case Manager - Ochsner St Mary - PRN

About the Role

This position handles multi-disciplinary communications and facilitation of care throughout a patient’s hospitalization. Responsibilities include reviewing appropriate utilization of resources while respecting the patient’s right to self-determination. The role involves reviewing patient hospitalizations, recommending medically necessary levels of care, and confirming clear documentation in the medical record. You may discuss alternative care options with Emergency Department (ED) physicians or attending physicians. As a liaison, you will communicate with patients, caregivers, multi-disciplinary team members, post-acute providers, and third-party payers. Additionally, you will collaborate with the care team to develop and implement discharge plans tailored to each patient’s needs.

Responsibilities

• 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 while maintaining minimum standards for licensure and pursuing personal/professional development.
• Maintains knowledge of conditions of participation related to utilization review and discharge planning.
• Acts as a liaison between ED physicians, hospitalists, attending physicians, and physician advisors, ensuring open communication.
• Leads oversight and management of functional and financial outcomes, including coordination and implementation of the discharge plan during acute-care hospitalization.
• Adapts behavior to specific patient populations, including respecting privacy, tailoring explanations, and adjusting communication styles.
• Remains knowledgeable about current federal, state, and local laws, accreditation standards, or regulatory requirements applicable to the assigned area and ensures compliance.
• Performs other related duties as required.

Requirements

• Graduate of an accredited school of nursing.
• Current registered nurse license in the state of practice.
• Basic Life Support (BLS) certification from the American Heart Association.
• Proficiency in using computers, software, and web-based applications.
• Effective verbal and written communication skills, with the ability to present information clearly and professionally.
• Strong interpersonal skills.
• Ability to work a flexible schedule, including weekends, holidays, and on-call availability.

Preferred Qualifications

• Bachelor’s degree in nursing.
• 3 years of hospital-based experience in discharge planning, case management, or utilization review.
• Certification in Case Management (CCM) or Accredited Case Manager (ACM).

Physical and Environmental Demands

The physical demands described are representative of those required to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

• Medium Work: Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects.
• Duties are performed routinely in patient care areas, with exposure to blood, body fluids, and tissue.
• Occupational risk for exposure to communicable diseases, hazardous medications, or hazardous waste within the healthcare environment.