RN Case Manager - Kings Hwy

Job Summary

This position involves multi-disciplinary communication and facilitation throughout a patient’s hospitalization, including review of resource utilization and balancing patient rights to self-determination. The role reviews hospitalizations, recommends appropriate levels of care that meet medically necessary criteria, confirms clear level of care orders, and documents all actions in the medical record. It may discuss alternative care options with ED or attending physicians and serves as liaison communicating with patients, caregivers, multi‑disciplinary team members, post‑acute services, and third‑party payers.

Responsibilities

• Perform pre‑admission, admission, and continued stay reviews per CMS guidelines, commercial payer guidelines, and hospital policy.
• Review patient hospitalizations and recommend a level of care that meets medically necessary hospital care criteria.
• Confirm a clear, specific level of care order and other appropriate documentation in the medical record.
• Communicate with ED physicians, hospitalists, attending physicians, and physician advisors regarding patient status and discharge planning.
• Collaborate with the care team to develop and implement discharge plans based on individualized patient needs.
• Lead oversight and management of functional and financial outcomes, including coordination and implementation of discharge plans during acute‑care hospitalization.
• Maintain open communication with all appropriate parties while functioning as a liaison between ED physicians, hospitalists, attending physicians, and physician advisors.
• Maintain knowledge of Conditions of Participation regarding utilization review and discharge planning.
• Adapt communication style to specific patient populations, respecting privacy and ensuring clear explanations of services and procedures.
• Perform other related duties as required and as stipulated by the department or organization.

Education

• Required: Registered Nurse Diploma or equivalent.
• Preferred: Bachelor’s degree in Nursing.

Experience

• Required: 3 years hospital‑based experience.
• Preferred: Experience in discharge planning, case management, or utilization review.

Certifications

• Required: Current State of Louisiana Registered Nurse license.
• Required: Basic Life Support (BLS) from the American Heart Association.
• Preferred: Certification in Case Management (CCM) or Accredited Case Manager (ACM).

Knowledge, Skills, and Abilities

• Proficient computer skills and dexterity required for data entry and retrieval of patient information.
• Proficiency with Windows‑style applications and keyboard use.
• Effective verbal and written communication skills, with the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
• Strong interpersonal skills.

Physical and Environmental Demands

Medium work – exerting 20 to 50 pounds of force occasionally, 10 to 25 pounds frequently, or up to 10 pounds constantly to move objects. Requires walking or standing to a significant degree, may involve pushing or pulling of small objects, and must be able to stand for prolonged periods. Flexible schedule may be required (24/7, weekend, holiday, on call). Duties routinely require exposure to blood, body fluids and tissue. Occupational risk for communicable diseases exists.

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties of this role.

Equal Opportunity Employer

Ochsner is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.