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Lead, Onsite Inpatient Case Management - Atlanta

Location: Atlanta, GA Job Number: 917672 Date posted: 11/26/2020

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Responsible for supporting the Manager, Inpatient Case Management. This includes completion of designated assignments as well as being a first line resource for the Inpatient Case Managers and Support Staff. Assist with completing monthly support team audits and identification of areas of opportunity for improvement as needed. Other activities will include assisting as a preceptor for new staff members and assisting with resolving claims issues on a daily basis. Will still have a patient assignment but may be reduced as dictated by the overall census.

Essential Responsibilities:

  • Acts as a resource for the onsite ICM team as well as physicians, health plan administrators and contracted vendors. He/she will assist with problem solving and difficult cases.

  • Functions as an Inpatient Case Manager with a reduced assignment.

  • Completes monthly audits for ICM support team.

  • Acts as a team coach for respective areas of responsibility regarding enhanced customer service, quality of work performed and productivity of staff.

  • Assists in the development and revision of guidelines, pathways and protocols.

  • Ensures that the appropriate level of care is being delivered in the most appropriate setting.

  • Maintains effective interaction/communication with members of the medical staff, nursing staff, Transitions of Care team, complex case managers, Palliative Care team, social workers, SNF/DME vendors to facilitate the inpatient utilization management process and to provide continuity of care.

  • Under the guidance of the Manager, Inpatient Case Management, participates in the coordination, planning, development, implementation, and maintenance of all IQM policies and procedures related to the Onsite Inpatient Case Management Program.

  • Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements, and Kaiser Permanente's policies and procedures.

  • Access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform your job.
  • Basic Qualifications:
  • Minimum two (2) years of experience in utilization management, case management, discharge planning in a managed care setting.
  • Minimum three (3) years of current clinical nursing in an acute care setting, preferably in Emergency Medicine or Critical Care.
  • Education
  • High School Diploma or General Education Development (GED) required.
  • License, Certification, Registration
  • Unrestricted current RN licensure in the state of Georgia required.

  • Additional Requirements:
  • Experience with managed health care delivery including Medicare.
  • Functional knowledge of computers.
  • Working knowledge of all federal, state, local and regulatory requirements.

  • Preferred Qualifications:
  • Minimum two (2) years of supervisory/lead experience in UM/Case Management in an HMO/insurance industry or hospital case management/discharge planning environment. 
  • Bachelor's degree in nursing OR four (4) years of experience in a directly related field.

  • Notes:
  • Variable M-F, alternate weekends
  • Primary Location: Georgia,Atlanta,Emory University Hospital - Midtown Scheduled Weekly Hours: 40 Shift: Variable Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: 8:30 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-GA-01|NUE|Non Union Employee Job Level: Individual Contributor Job Category: Nursing Licensed Department: Medical Office Administration Travel: Yes, 5 % 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.

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