Admission criteria knowledge including icd and cpt codes
Utilization review and medical necessity guidelines
Pre-admission and continued stay reviews per cms guidelines
The role coordinates, negotiates, procures, and manages the care of complex patients to facilitate achievement of quality and cost outcomes
Job Summary
The role coordinates, negotiates, procures, and manages the care of complex patients to facilitate achievement of quality and cost outcomes.
Employees at Ochsner Health are dedicated to serving, healing, leading, educating, and innovating to make a difference in patient lives.
The position requires performing pre-admission, admission, and continued stay reviews directed by content management systems or commercial payer guidelines.
Matching Summary
The role coordinates, negotiates, procures, and manages the care of complex patients to facilitate achievement of quality and cost outcomes.
Skills & Requirements
Must-have
Admission criteria knowledge including ICD and CPT codes
Utilization review and medical necessity guidelines
Pre-admission and continued stay reviews per CMS guidelines
Collaboration with multi-disciplinary teams for authorization
Strategies to reduce length of stay and resource consumption
Nice-to-have
Experience in utilization review preferred
Effective verbal and written communication skills
Ability to adapt behavior to specific patient populations
Proficiency with Windows-style applications and data entry
Key Requirements
Graduate of an accredited licensed practical nurse program
3 years of hospital-based experience required
Current licensed practical nurse license in state of practice