RN Utilization Manager – OLG Case Management

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Assess the psychosocial, environmental, familial, and economic factors influencing patients.

• Validate physician-specific orders for care settings and adhere to hospital-sanctioned medical necessity guidelines.

• Evaluate suitable admissions, care levels, and extended stays.

• Record finalized assessments in the hospital-sanctioned data system.

• Engage in discussions regarding alternative care options with emergency department, admitting, or attending physicians as needed.

• Act as a liaison and communicator among patients, caregivers, multidisciplinary teams, post-acute care providers, and third-party payers.

• Conduct pre-admission, admission, and ongoing stay activities.

• Ensure continuous communication with relevant stakeholders.

• Oversee the planning for patients' transitions within the healthcare system.

• Collaborate with managed-care and third-party payers to secure financial certification, ensure appropriate reimbursement, and reduce denials.

• Oversee the care of assigned patients throughout the healthcare system based on their individual requirements.

• Ensure adherence to relevant laws, accreditation standards, and regulatory mandates.

• Report any known or suspected unethical, questionable, safety, privacy, or compliance-related issues.

⛳️ Requirements

• Diploma in Nursing or an equivalent qualification.

• Minimum of 1 year of hospital-based patient care experience.

• Valid RN License in the state of practice.

• Proven ability to work independently as well as collaboratively within a team environment.

• Experience in positively responding to changes and maintaining composure and efficiency in high-pressure situations.

• Competence in computer skills and dexterity for data entry and patient information retrieval.

• Proficiency in using Windows-style applications and keyboarding.

• Strong verbal and written communication abilities.

• Exceptional conflict resolution skills.

• Understanding of business, financial concepts, and healthcare delivery systems.

• Preferred experience in Case Management or Utilization Review.

• Willingness to work a flexible schedule, including 24/7 shifts, weekends, holidays, and on-call duties.

• Capability to meet light physical demands, sit for extended periods, and perform tasks involving stooping, bending, reaching, grabbing, and manual dexterity.

• Ability to work in healthcare settings with potential exposure to blood, bodily fluids, communicable diseases, hazardous medications, and hazardous waste.

🏝️ Benefits

• Full-time employment.

• Remote work available Monday to Friday, from 8:00 AM to 4:30 PM.