RN Utilization Manager – OLG Case Management

Ochsner Health

. Determine psychosocial, environmental, family, and economic dynamics affecting patients .

Posted 9/30/2026full-timeRemote • Louisiana • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in patient care management, including psychosocial assessments, compliance with healthcare regulations, and effective communication with multidisciplinary teams. Proficient in case management and utilization review, ensuring optimal patient movement through the healthcare system.

Highest-signal resume keywords

Registered Nurse LicenseCase Management ExperienceUtilization Review ExperienceEffective Communication SkillsBusiness and Financial Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Patient Care ManagementData Entry and RetrievalCompliance with Regulatory RequirementsMedical Necessity Criteria ApplicationConflict Resolution

Soft Skills

Team CollaborationAdaptability in High-Pressure SituationsOpen Communication

Tools & Technologies

Windows-Style Applications

Certifications & Qualifications

Registered Nurse Diploma

Industry Keywords

Healthcare Delivery SystemsManaged-Care InteractionFinancial CertificationAccreditation StandardsPatient Movement Planning

About the role

Key responsibilities & impact

Determine psychosocial, environmental, family, and economic dynamics affecting patients
Confirm physician-specific care setting orders and apply hospital-approved medical necessity criteria
Review appropriate admissions, levels of care, and continued stays
Document completed reviews in the hospital-approved data set
Discuss alternative care options with ED, admitting, or attending physicians when appropriate
Serve as liaison and communicator with patients, caregivers, multidisciplinary teams, post-acute care providers, and third-party payers
Perform pre-admission, admission, and continued-stay activities
Maintain open communication with appropriate parties
Manage planning for patients’ movement through the healthcare system
Interact with managed-care and third-party payers to obtain financial certification, secure appropriate reimbursement, and minimize denials
Manage assigned patients’ care through the healthcare system based on individual needs
Maintain compliance with applicable laws, accreditation standards, and regulatory requirements
Report known or suspected unethical, questionable, safety, privacy, or compliance-related concerns

Requirements

What you’ll need

Registered Nurse Diploma or equivalent
1 year of hospital-based experience in the delivery of patient care
Current RN License in the state of practice
Experience functioning independently and working well within a team setting
Experience responding to change positively and working calmly and efficiently in high-pressure situations
Computer skills and dexterity for data entry and retrieval of patient information
Proficiency with Windows-style applications and keyboard
Effective verbal and written communication skills
Excellent conflict resolution skills
Business and financial knowledge and understanding of health care delivery systems
Experience in Case Management or Utilization Review preferred
Ability to work a flexible schedule, including 24/7, weekends, holidays, and on-call availability
Ability to meet light-work physical demands, sit for prolonged periods, and perform stooping, bending, reaching, grabbing, and manual dexterity tasks
Ability to work in healthcare environments with potential exposure to blood, body fluids, communicable diseases, hazardous medications, and hazardous waste

Benefits

Comp & perks

Full-time employment
Remote work Monday–Friday, 8:00 AM–4:30 PM