RN Recovery Nurse Specialist- OLGMC Utilization Management- Full Time Remote

Required - Registered Nurse Diploma

Preferred - Associate's or Bachelor's degree in Nursing

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, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Vermont, Washington, and Washington D.C.

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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.

Required - 3 years Hospital based experience in the delivery of patient care as an RN.  Experience in Case Management, Utilization Review and/or Discharge Planning .either in the Acute Care environment or Managed Care environment.  Experience responding to change positively and work calmly as well as efficiently in high pressure situations.
Experience functioning independently and working well within a team setting.

Preferred - Experience in Appeal/Denial Management

Required - Current Registered Nurse (RN) License in the state of practice

Preferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review, Utilization Management or Health Care Management (CPUR, CPUM, and CPHM)

• Must have computer skills and dexterity required for data entry and retrieval of patient information.
• Must be proficient with Windows-style applications, various software packages specific to role and keyboard.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process
• Strong financial skills

• Validates a specific level of care and evaluates against registered level of care to determine which medical necessity level of care is required. 
• Reviews all incoming denial and informational requests from regulatory and other agencies in respect to clinical medical necessity determinations. 
• Identifies, plans, and coordinates aspects of medical necessity reviews with others as necessary. 
• Maintains current knowledge of third party payer and government requirements related to job functions.
• Maintains minimum standards for licensure and strives for professional/personal development.
• 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.