[Hiring] RN Utilization Manager @Ochsner Health

Role Description

This job is a registered Nurse 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.

Schedule: Remote M-F 8AM-4:30PM

Qualifications

• Required - Registered Nurse Diploma or equivalent

Requirements

• Required - 1 year of Hospital based experience in the delivery of patient care
• Experience functioning independently and working well within a team setting
• Experience responding to change positively and working calmly as well as efficiently in high pressure situations
• Preferred - Experience in Case Management or Utilization Review
• Business and Financial Knowledge as well as understanding of Health Care Delivery Systems
• Required - Current RN License in the state of practice

Knowledge Skills and Abilities (KSAs)

• Must have computer skills and dexterity required for data entry and retrieval of patient information
• Must be proficient with Windows-style applications and keyboard
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process
• Excellent conflict resolution skills
• Ability to respond to change positively and work calmly, as well as efficiently in high pressure situations
• Ability to function independently and work well within a team setting
• Sense of objectivity, strong ethical principles, professionalism, sense of humor, strong work ethic, energy, and creativity

Job Duties

• 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
• Other related duties as required

Physical and Environmental Demands

• Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly
• Mechanical lifting devices (carts, dollies, etc.) or team lifts should be utilized
• Must be able to stoop, bend, reach and grab with arms and hands, manual dexterity
• Must be able to sit for prolonged periods of time
• Must be able to work a flexible schedule (e.g. 24/7, weekend, holiday, on call availability)
• Duties performed may 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
• There may be occupational risk for exposure to hazardous medications or hazardous waste within the environment

Application Information

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 following areas are not eligible for remote work position: Colorado, California, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Vermont, Washington, and Washington D.C.

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 protected]. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

Ochsner is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to any legally protected class, including protected veterans and individuals with disabilities.