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 coordinates, negotiates, procures and manages the care of complex patients to facilitate achievement of quality and cost outcomes for admission to the facility, diagnostic procedures, or clinical specialties. Serves as a resource for physician and multi-disciplinary team members to obtain information regarding current charges, reimbursement and payor source limitations.ShiftM - F 8 am - 4:30 pm, rotating weekendsEducationRequired – Graduate of an accredited licensed practical nurse (LPN) program.Work ExperienceRequired – 3 years of hospital-based experience.Preferred - Experience in utilization review.CertificationsRequired – Current licensed practical nurse (LPN) license in the state of practice.Knowledge Skills and Abilities (KSAs)
Working knowledge of admission criteria including, International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes and Medical Necessity guidelines.
Computer skills and dexterity for data entry and retrieval of information.
Effective verbal and written communication skills and ability to present information clearly and professionally.
Proficient with Windows-style applications, various software packages specific to role and keyboard.
Job Duties
Performs pre-admission, admission, and continued stay reviews as directed per content management system (CMS) or commercial payer guidelines and/or hospital policy.
Collaborates with hospital staff, as required, for authorization/certification processes.
Explores strategies to reduce length of stay and resource consumption for case managed patient populations.
Identifies appropriate patients for the various third-party payor pre-certification or pre-authorization process.
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.
Performs 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.This employer maintains and complies with its 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.The employer 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 DemandsThe 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.Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.The incumbent has no occupational risk for exposure to communicable diseases.Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.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 . 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 and its , as well as the for more information.
