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 plans, organizes and implements utilization management programs based upon individualized patient biopsychosocial assessments/reassessments and through the knowledge and use of Ochsner and community based non-acute services to coordinate and implement complex discharge plans. Provides information and referral to governmental and community resources. Collaborates and communicates (verbally and through maintenance of the medical record) with the multidisciplinary team to (re)evaluate and respond to patient’s biopsychosocial and appropriate spiritual and cultural needs. Demonstrates actions consistent with Ochsner guiding principles as duties are performed on a daily basis. When needed will assist with daily clinical review of patient’s medical records for utilization review purposes. Works independently with minimal supervision under the direction of Registered Nurse Case Managers. Communicates the clinical review either verbally or in writing to insurance companies, Registered Nurse Case Manager or other members of the health care team. Performs duties under general supervision and following complex procedures and guidelines.
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 - Associates degree

WORK EXPERIENCE

Required - 1 year experience in Health care.

KNOWLEDGE SKILLS AND ABILITIES (KSAS)

• Must have computer skills and dexterity required for data entry and retrieval of information.
• Effective verbal and written communication skills and the ability to present information clearly and professionally.
• Must be proficient with Windows-style applications, various software packages specific to role and keyboard.
• Strong interpersonal skills.
• Possess the ability to respond to high volume, fast paced clinical and office setting.
• Dynamic knowledge of managed care and public programs such as those funded by Medicare (especially Medicare risk products), Medicaid, and other payers 3rd party.
• Maintain a professional, neat work environment, manages stress in order to maintain a professional demeanor and perform multiple tasks simultaneously.
• Ability to promotes a positive image of Ochsner Medical Center while maintaining strict confidentiality.

• Under the direction of the Case Manger Director perform Discharge Planning functions for the Case Management Department.
• Responsible for arranging referrals for post discharge needs of patient and or family choice.
• Communicates with physicians, nurses, therapies, case managers and third party payer regarding the discharge plan.
• Under the direction of a RN Case Manger performs utilization review functions for the Case Management Department.
• Demonstrates participation in professional growth and development, maintaining required knowledge and skills needed to perform the duties of the position.
• Adapts behavior to the specific patient 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.