Top 28 Utilization management nurse Jobs in Hammond, La

CASE MGMT MANAGER - CASE MANAGEMENT
North Oaks Health System —Hammond, LA
- Weekends as needed
- Nursing
- RN License
- Hospital
5d
RN Outpatient Care Manager - Covington-FT
Ochsner Health System —Covington, LA
- Full-time
- Nursing
- RN License
- Primary Care
10d
Registered Nurse - RN
Optum —Hammond, LA
- $41.35 - $62.03 an hour
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
2d
CHARGE NURSE - TELE-EXPANSION
North Oaks Health System —Hammond, LA
- 12 hour shift
- Nursing
- RN License
- Hospital
LPN Behavioral Health
Eating Disorder Treatment Centers LLC —Covington, LA
- Nursing
- Vital signs
- Mid-level
Quick Apply
CHARGE NURSE - TELEMETRY EAST
North Oaks Health System —Hammond, LA
- 12 hour shift
- Nursing
- RN License
- Hospital
CHARGE NURSE - GENERAL SURGERY UNIT
North Oaks Health System —Hammond, LA
- Full-time
- Nursing
- Surgery
- RN License
CHARGE NURSE - ORTHO NEUROSURGERY
North Oaks Health System —Hammond, LA
- Full-time
- Nursing
- RN License
- Hospital
CHARGE NURSE - TELEMETRY NORTH
North Oaks Health System —Hammond, LA
- Full-time
- Nursing
- RN License
- Hospital
LPN (Licensed Practical Nurse)
Longbranch Healthcare —Abita Springs, LA
- Part-time
- Background check
- Nursing
- Psychiatry
- Health insurance
- Dental insurance
Quick Apply
RN/WOC SERVICES - WOUND OSTOMY CONTINENCE
North Oaks Health System —Hammond, LA
- Part-time
- Nursing
- Management
- RN License
RN Clinical Manager Peds Private Duty - Covington
Optum —Covington, LA
- $51,528 - $77,292 a year
- Full-time
- Nursing
- RN License
- Pass drug screening
Quick Apply
11d
CRNA - Full-Time - AVALA Hospital
AVALA —Covington, LA
- Full-time
- Nursing
- Surgery
- RN License
Registered Nurse - Hospice - On Call
VitalCaring Group —Hammond, LA
- Holidays
- CPR Certification
- Nursing
- RN License
- Continuing education credits
- Health savings account
CRNA - PRN - AVALA Hospital
AVALA —Covington, LA
- PRN
- Nursing
- Surgery
- RN License
PRN CRNA - Lakeview
LCMC Health —Covington, LA
- Part-time
- Nursing
- Surgery
- RN License
Quick Apply
CRNA - Covington
LCMC Health —Covington, LA
- Full-time
- Nursing
- Surgery
- RN License
Quick Apply

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utilization management nurse jobs near hammond, la

CASE MGMT MANAGER - CASE MANAGEMENT

North Oaks Health System -
Hammond, LA

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Job Details

Full-time
5 days ago

Qualifications

Appeals
Direct patient care
RN License
Transitional care planning in clinical case management
Case appeal in utilization management
Health information regulatory compliance
Acute care experience
Case referral
Hospital regulatory compliance
Insurance claims appeal handling

Full Job Description

Status: Full Time

Shift: 40 hours/week, Monday–Friday, exempt salaried position

Exempt: Yes

Other information:

1. Previous Experience:

a.5 years nursing experience with a minimum of 3 years acute patient care required.

b.Previous management experience preferred.

c.Utilization Management/Case Management experience preferred.

2.Specialized or Technical Education

a.Registered Nurse licensed to practice in the State of Louisiana.

b.MSN/BSN preferred

c.Knowledge of established medical necessity criteria and their application necessary.

d.Knowledge of the Inpatient and Outpatient Prospective Payment Systems – MS-DRG’s, CPT, ICD10-CM and HCPCS coding, is strongly preferred.

e.Knowledge of Social Services, discharge planning, community resources, and referral agencies required.

f.Basic knowledge of Legal Compliance/HIPAA and their application in Case Management practice is necessary.

g.Knowledge of third party payor methodologies and appeal processes necessary.

h.Knowledge of Quality Improvement activities/Team Leader/Facilitator training preferred

3.Physical Effort Required/Physical Demands:

Strength:Light
Push:Occasionally
Pull:Occasionally
Carry:Occasionally
Lift:Occasionally
Sit:Frequently
Stand:Frequently
Walk:Frequently

Responsibilities:

A.Provides direct supervision for all staff in Case Management Department - RN Care Managers, Social Workers, ER Case Managers, Utilization Review Nurses, Patient Flow Navigator Nurses, and Volunteers.

B.Performs annual appraisal of employee performance for employees/positions supervised.

C.Informs the Case Management Director of any concerns, activities, and ideas for improvement brought to the manager by any member of the Medical Staff, other hospital or Case Management department staff.

D.Identifies issues and assists the Department Director in any disciplinary actions required by the employees supervised.

E.Determines staffing levels and ensures adequate coverage in all areas.

F.Responsible for reviews and updates of departmental policies and procedures, all department job s, and Plan of Care on an annual basis.

G.Maintains daily working knowledge of in-house cases and knows discharge plan for any patient with a length of stay greater than 5 days.

H.Informs the Case Management Director of any cases which do not meet criteria for admission or continued stay as well as cases with known or suspected problems with utilization of services.

I.Serves as the backup for the Case Management staff by being available by phone after hours, on weekends, and holidays. Reports to hospital when necessary to carry out the functions of the Case Management Department.

J.Responsible for the dissemination of information to the Case Management staff about changes in current rules, regulations, policies and procedures related to the Case Management Program.

K.Maintains working knowledge of screening criteria utilized in the Case Management process and is able to apply them objectively.

L.Maintains close professional ties to the Medical Staff and all hospital employees to facilitate the functions of the Case Management department.

M.Assists the Department Director with ongoing staff education and preparedness for Medicare, JCAHO, CARF and other accreditation surveys.

N.Oversees Utilization Review processes, including daily reviews, initial and continued stay authorizations, reconsiderations, and workque management.

O.Responsible for maintaining the daily functions of the department and overseeing all Case Management activities in the absence of the Department Director.

P.Assists the Director in monthly budget monitoring and analysis. Also assists the Director in annual departmental budget preparation and presentation.

Q.Follows North Oaks Health System’s Compliance Programs and Federal and State Regulatory guidelines.

R.Other duties as instructed by Case Management Director.

Apply Now

Refine Your Search

utilization management nurse jobs in hammond, la

CASE MGMT MANAGER - CASE MANAGEMENT

RN Outpatient Care Manager - Covington-FT

Registered Nurse - RN

CHARGE NURSE - TELE-EXPANSION

LPN Behavioral Health

CHARGE NURSE - TELEMETRY EAST

CHARGE NURSE - GENERAL SURGERY UNIT

CHARGE NURSE - ORTHO NEUROSURGERY

CHARGE NURSE - TELEMETRY NORTH

LPN (Licensed Practical Nurse)

RN/WOC SERVICES - WOUND OSTOMY CONTINENCE

RN Clinical Manager Peds Private Duty - Covington

CRNA - Full-Time - AVALA Hospital

Registered Nurse - Hospice - On Call

CRNA - PRN - AVALA Hospital

PRN CRNA - Lakeview

CRNA - Covington

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