RN Outpatient Care Manager - Covington-FT
On-siteCovington, Louisiana, United States
Job Summary
Manage complex and catastrophic patients assigned to Ochsner Network Primary Care Physicians by identifying high-risk individuals and collaborating with the care team to implement coordinated treatment plans across the continuum. Utilize the case management process to develop comprehensive, cost-effective plans, negotiate services, and coordinate referrals with payors, community resources, and alternate levels of care including SNFs and rehab facilities. Monitor plan effectiveness, modify strategies as needed, and provide education to patients and caregivers to reduce hospital admissions. Transition patients to Health Coaches or other team members upon discharge from formal case management and submit identified quality issues to the quality department.
Required Qualifications
- Registered Nurse in the state of Louisiana
- Certification as a Case Manager (CCM)
- 6 years experience in managed care, utilization or quality management, regulatory compliance, medical management or other related MCO departments/functions
- Certification as a CCM
- Experience with data capture in a Care Management software system, such as CaseTrakker, CCMS, Amisys, and Facets
- Experience with Microsoft Office software tools
- Three years experience in managed care, utilization or quality management, regulatory compliance, medical management or other related MCO departments/functions
- BSN
- 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
- Excellent knowledge of managed care, CMS, Medicaid and other regulatory standards/requirements
- Knowledge and experience in using, community resources and other resources to facilitate the patient's care throughout the care continuum
- Good organizational skills
- Strong written and verbal communication skills
- Strong time management skills
- Self directed
- Demonstrates Good Judgement
- Must be able to lift 20 pounds of force occasionally
- Must be able to lift 10 pounds of force frequently
- Must be able to exert a negligible amount of force constantly
- Must reside in and work from an area other than Colorado, California, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New York, Vermont, Washington, Washington D.C.
Desired Qualifications
- Bachelor's degree in Nursing
- Additional degrees
- Business training experience
- Certifications
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