Case Manager - Out Lady of Lourdes Hospital

Case Manager uses services, staff and other efforts to engage high risk members learning health self-management skills in order to enjoy a better quality of life and control their own health care dollars through navigation, collaboration and coordination of care within the complicated health services environment optimizing access and good health care

choices, including education on symptom and risk management to identify appropriateness utilization. This position relies on education, experience, professional training and judgment to plan and assist the member in accomplishing health goals. A wide degree of creativity and latitude is expected, works under minimal supervision and may lead and direct the work of


Job Duties

  • Assists health plan member to set realistic goals using system tools and judgement
  • Gain trust to assure disease based, high risk or high utilization individuals set and meet or exceed targets
  • Consistently measures and communicates with the individual on goal status and documents progress and measures of improvement using system tools
  • Process includes constant communication, psycho-social skills and disease management care plans such as obesity, diabetes and hyperlipidemia
  • Coordinates care team around individual to assure obstacles to goals are removed including such activities as making appointments, assuring prescriptions are filled, directing care to physicians, specialists, EAP or other providers
  • Uses system tools to monitor, identify, and facilitate in the closing of gaps in care and collaborates with members encouraging compliance in order to achieve health status goals
  • Communicates effectively with the provider to assure that the panel of individuals is on track with health goals.
  • Monitors care plans including outcomes for measurement of disease, wellness and other goals
  • Ensures that services provided to members maintains or improves member health status, optimizes benefits available within health plan, and improves overall patient satisfaction of services delivered

Minimum Requirements & Education

3 years of general or specialty nursing practice

Current Louisiana State RN

Case Management Certification, Case Management Certification or equivalent preferred