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Quality Assurance, UR & Case Management

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Ensure consistency and the highest ethical standards across our entire organization. Our quality assurance team drives ongoing improvement by fostering an environment of support, providing technical and specialized consultative services, and inspiring ongoing excellence.

Manager, Inpatient Continuing Care Case Management, RN - Arlington, VA

Location: Arlington, VA Job Number: 905117 Date posted: 09/02/2020

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Description:
The Manager of Inpatient Continuing Care serves as liaison between Kaiser Permanente (KP) Health Plan, MAPMG providers, staff and faculty at hospital facilities, to facilitate open communication and ensure smooth transitions of care between KP and other care delivery systems. This position is also responsible for supervising and managing teams of personnel who support utilization management, transitions of care and discharge planning activities.  This position ensures compliance with NCQA, state, federal and other regulatory accreditation standards.

Essential Responsibilities:
  • Performs as an organizational liaison between Health Plan, MAPMG providers and faculty and staff at facility. Promotes relationships and communication between KP members, Health Plan, MAPMG providers and faculty and staff at facility. Develops collaborative relationships within MAPMG, facility faculty and staff and other KP departments to provide and facilitate transitions of care.
  • Manages and directs Patient Care Coordinators and support staff to ensure utilization management and discharge planning activities are applied in a consistent and effective manner. Oversees day to day activities of assigned staff, to include staff scheduling, caseload assignment, appropriate utilization of resources and timely discharge planning.
  • Ensures member benefits are interpreted and applied correctly and in compliance with state and federal regulations.
  • Conducts case level reviews and provides feedback to Patient Care Coordinator staff on a regular basis.
  • Participates in multidisciplinary rounds. Ensures that transitions of care to alternative levels of care are smooth and coordinated with Health Plan, facility, providers and KP member/family.
  • Provides support and oversight of UM activities (i.e., use of UM guidelines / criteria and UM processes).
  • Partners with other members of the UMOC and Continuing Care teams to develop and implement collaborative processes.
  • Supports professional growth by providing education, training and appropriate resources.Conducts performance evaluations, provides coaching and acts as a mentor to direct reports.
  • Performs other related duties as assigned.

    • Physically located at Virginia Hospital Center
    but will have oversight and travel to Reston Hospital Center and Stafford
    Hospital.


    Basic Qualifications:
    Experience
  • Minimum of five (5) years of experience in a clinical setting.
  • Minimum of two (2) of the five (5) years of experience as a Registered Nurse OR in Utilization Management OR Case Management.
  • Minimum of two (2) of the five (5) years of supervisory OR as a Kaiser Permanente Patient Care Coordinator experience.
    • Education
  • Bachelor's degree in nursing, health care administration or related field.
    • License, Certification, Registration
  • Must hold valid RN license in the jurisdiction of hire (MD, DC or VA - compact state acceptable) at time of hire.
  • Must obtain valid RN license in the other two jurisdictions (MD, DC or VA) within 6 months of hire.
  • Current American Heart Association BLS required.

    • Additional Requirements:
  • Proficient in computer applications including Microsoft Word, PowerPoint and Excel required.
  • Strong interpersonal skills, with good verbal and written communication skills required.
  • Skills in problem-solving and collaboration with other professions/ disciplines required.
  • Ability to work comfortably and effectively in a hospital and managed care setting required.

    • Preferred Qualifications:
  • Experience working with various member populations in a community setting.
  • Knowledge of KP or other integrated health care delivery system.
  • Working knowledge of KP or experience working with state Medicaid/Medicare plans.
  • Certification in Case Management from Commission for Case Manager Certification or Nursing Case Manager Certification from American Nurses Credentialing Center.
    •  
  • Master's degree in nursing, health care administration or related field.
    •
    Primary Location: Virginia,Arlington,Virginia Hospital Center Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri with occasional weekend on call Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-MAS-01|NUE|Non Union Employee Job Level: Manager with Direct Reports Job Category: QA / UR / Case Management Department: Utlization Management Travel: Yes, 25 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    Click here for additional requirements >

    Navigating the Hiring Process

    We're here to support you!

    Having trouble with your account or have questions on the hiring process?

    Please visit the FAQ page on our website for assistance.

    Need help with your computer and browser settings?

    Please visit the Technical Information page for assistance or reach out to the web manager at kp-hires@kp.org.

    Do you need a reasonable accommodation due to a disability?

    A reasonable accommodation is any modification or adjustment that enables you to fully participate in completing the following:

    • Online Submissions
    • Pre-Hire Assessments
    • Interview Process

    Please submit your accommodation request and an HR Representative will contact you.

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