The Front Line of Patient Care
Our nurse professionals embody what it means to provide the best patient interactions possible. They also advance the art and science of nursing in a patient-centered, healing environment.
Case Manager Utilization RN-PDLocation: Harbor City, CA Additional Locations:
Job Number: 841917 Date posted: 01/11/2020
- Plans, develops, assesses and evaluates care provided to members.
- Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use.
- Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
- Assesses high risk patients in need of post-hospital care planning.
- Develops and coordinates the implementation of a discharge plan to meet patient's identified needs; communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies.
- Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
- Participates in the Bed Huddles and carries out recommendations congruent with the patient's needs.
- Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
- Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non-KFH facilities.
- Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
- Refers patients to community resources to meet post hospital needs.
- Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation.
- Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOL.
- Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
- Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
- Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities.
- Reviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
- Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed.
- Participates in committees, teams or other work projects/duties as assigned.
- Two (2) years of clinical experience as an RN in an acute care setting required.
- Completion of an accredited RN training program that allows graduates to take RN license exam.
- Current California RN license required.
- Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review / management, discharge planning or case management.
- Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
- Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills.
- Demonstrated ability in planning, organizing, conflict resolution and negotiating skills.
- Computer literacy skills required.
- Bachelor's degree in nursing or health care related field preferred.
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.
About Nursing & Physician Assistant Careers
Through professional practice and leadership, nurses at Kaiser Permanente continually advance the art and science of nursing. But we recognize that what we do is more than clinical practice. We believe that every interaction — whether it is with a patient, a colleague, a physician, or anyone else — has the potential to be extraordinary. And we find that approaching our daily routine with this in mind gives each and every action new meaning and allows us to focus on the moment, empowering us to deliver expert care.
No matter where you are in your nursing career, the size and scope of our organization means you have the resources, technology, tools, and support you need to make a lasting impact.
Physician Assistant Careers
Physician assistants play a powerful and important role in delivering high-quality, informative care. Working directly with patients, their families, colleagues, and supervising physicians, they are vital in defining the overall care experience.
Being a physician assistant at Kaiser Permanente is centered on promoting a healing environment — one that maintains a caring, comforting practice while honoring the unity of the whole patient: mind, body, and spirit.
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