Description

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!

The Manager manages complex/catastrophic patients assigned to Ochsner Network Primary Care Physicians. Utilizes the Case Management process to assess the health care needs of the enrollee, develop a comprehensive treatment plan complete with specific goals and objectives, implement a treatment plan in collaboration with the PCP team and the other providers involved in the patient's care, negotiate and coordinate services for the patient, monitor and evaluate the effectiveness of the plan in achieving the goals and objectives, and change and modify the plan as needs and situations change. This job is embedded within the Primary Care Practice and participates as a key team member in the Patient Centered Medical Home. Assumes responsibility for coordinating care among multiple healthcare providers, the patient's caregiver(s), community services, payors, and others involved in the care of the patient to ensure services are provided seamlessly throughout the continuum of care. Arranges and coordinates resources necessary to manage the patient's disease processes in the home environment and at alternate levels of care (SNF/LTAC/Rehab/Custodial Nursing Home) throughout the care continuum and adheres to the CMSA Standards of Practice for Case Management.
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

Preferred - Bachelor's degree in Nursing, additional degrees, business training experience and/or certifications may be combined to meet minimum qualifications.

Work Experience
Required - 6 years experience in managed care, utilization or quality management, regulatory compliance, medical management or other related MCO departments/functions with 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.

Certifications

Required - Registered Nurse in the state of Louisiana

Certification as a Case Manager (CCM) required within 2 years of hire

Other

Required - Three years experience in managed care, utilization or quality management, regulatory compliance, medical management or other related MCO departments/functions with BSN

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.
• 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 and self directed
• Demonstrates Good Judgement

Job Duties
• Identifies patients with complex or catastrophic conditions who are at high risk and collaborates with members at the health care team, the patient and the patient's caregiver(s) to implement a coordinated treatment plan across the continuum.
• Utilizes the case management process to develop comprehensive cost-effective plans at care for patients in care management.
• Collaborates with the multidisciplinary team, PCP and other appropriate care providers to facilitate appropriate care and treatment of the patient
• Coordinates referrals and appointments with members of the care team and accompanies the patient as needed to appointments
• Provides education and community resources to members, families and/or caregivers to avoid or reduce hospital admissions through telephonic and face-to-face contact.
• Transitions the patient to the Health Coach or other appropriate team member when discharge from formal case management is appropriate
• Identifies quality issues that may adversely affect patient outcomes and submit to quality department

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.

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.

Please refer to the job description to determine whether the position you are interested in is remote or on-site. Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New York, Vermont, Washington, and Washington D.C.

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.

Ochsner is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to any legally protected class, including protected veterans and individuals with disabilities.