RN Utilization Manager

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 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. Functions as the liaison and communicator with the patient, caregivers, multi-disciplinary team members as well as third party payers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at Ochsner's discretion.

Education

Required

• High School diploma or equivalent

Work Experience

Required

• 3 years Hospital based experience in the delivery of patient care.

Experience responding to change positively and working calmly as well as efficiently in high pressure situations.

Experience functioning independently and working well within a team setting.

Certifications

Preferred

• Current State of Louisiana Registered Nurse LicenseCertified Case Manager (CCM) or American Case Management (ACM) certification

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.

• Must have computer skills and dexterity required for data entry and retrieval of information

• Must be proficient with Windows-style applications, various software packages specific to role and keyboard

• Excellent written and verbal communication skills

• Excellent conflict resolution skills

Job Duties

• Performs Pre-Admission, Admission and Continued Stay activities.

• Reviews all submitted clinical information for appropriateness of admission/assignment of level of care based on hospital approved medical necessity criteria set and appropriate documentation of findings in the hospital approved data set is completed.

• Maintains positive effective relationships and open communication with all appropriate parties.

• Gives directions and plans as well as being knowledgeable to give practical guidance.

• Identifies issues of medical necessity related to current level of care and collaborates to identify alternatives.

• Contributes to 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.

• Adapts behavior to the specific population, including but not limited to: respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.

Other related duties as required. The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

Complies with the Ochsner Health System Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.

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.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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 (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

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.

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, Washington, and New York.

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 careers@ochsner.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

We are proud to be an Equal Employment Opportunity and Affirmative Action employer. We are committed to the principles of equal employment opportunity and providing a workplace that is free from discrimination based on race, color, creed, religion, pregnancy status, pregnancy-related conditions, national origin, ancestry, mental or physical disability, medical condition, age, veteran status, military status, citizenship status, marital status, familial status, sexual orientation, gender, gender identity or expression, genetic information, political affiliation, unemployment status, or any other characteristic protected under applicable federal, state or local law. These protections extend to applicants and all employment related decisions. View the EEO is the Law poster and its supplement, as well as the pay transparency policy for more information.

Affirmative Action Policy Statement