Case Manager Pediatrics

Pediatric Case Manager works in a collaborative process of assessment, planning, facililtation, care coordination, evaluation, and advocacy for options and services to meet the child with special care needs and familys comprehensive health needs. The Pediatric Case Manager is responsible for providing care coordination services to a group of complex, special needs pediatric population and their families across the continuum of care. The Pediatric Case manager assesses, plans, implements, coordinates and evaluates the plan of care in partnership with the family, Pediatric Developmental Providers, Primary Care Provider and other members of the Health care team.

• Provides case management services for pediatric patients with special health needs to insure quality of care using an interdisciplinary approach. Utilizing the case management process, the Pediatric case manager performs a pediatric biopsychosocial assessment, identifies the pediatric clients needs, goals, and current services. Identifies potential pediatric clients for case management and verifies that the pediatric clients assignment for case management services is consistent with established guidelines and standards for the Case Management Society of America or the American Nurses Credentialing Center. Engages the pediatric client and family in the development of a case management plan and develops a client-focused case management plan.  Validates case management plan is consistent with evidence-based practice, regulatory, accreditation and regional guidelines Travels to different clinics around the state for patient care.
• Identifies and advocates for available resources within Hawaii Kaiser Region and within the community to meet established goals included in the case management plan. Integrates factors related to quality, safety, access, and cost effectiveness in assessing, monitoring, and evaluating resources for the pediatric client with special care needs. Develops, coordinates, implements and monitors population based activities/programs and plan of care to meet Regional goals, customer needs and regulatory requirements. Provides ongoing communication with health care providers.
• Serves as resource to staff. Develops and updates training and educational materials and presents to appropriate staff, members and families.
• Maintains and documents program activities. Creates and provides population-based reports on outcomes specific to pediatric patients.  Follows necessary documentation for billing and coding of services.
• Develops and implements plans/projects to improve operational efficiency and effectiveness. Monitors status and progress and reports to supervisor. Provides direct patient care on an as needed basis. Participates in problem solving and quality improvement monitoring. Identifies opportunities to improve care and services for special needs pediatric population and participates in strategic planning of program.
• May perform patient care to the extent necessary to maintain clinical expertise, competency, and licensing necessary to fulfill job responsibilities and to direct the provision of care on the unit.
• Provides direct patient care on an as needed basis. Provides services that are within scope of license and in compliance with all legal, regulatory, and policy requirements relevant to clinical role performed.
• Incorporates the KP Nursing Vision, Model and Values throughout their Nursing Practice.
• For RN Case Manager with Endocrinology or performing Diabetes Care Management:
• Serves as point of contact for the diabetes program for assigned area. Liaisons between Diabetes Team and local health care teams of assigned areas. Communicates regional diabetes program goals, policies, procedures, and program changes.
• Represents diabetes program on local health care teams in assigned area. Plans and coordinates monthly care management meetings. Integrates diabetes care and serves as change agent for assigned area. Mentors clinic-based RN care managers. Oversees competencies training and verification. Educates and trains new health care providers in diabetes model of care.
• Participates in monthly Diabetes Team meetings. Assists in developing, implementing, and evaluating Diabetes goals. Facilitates problem solving regarding case/care management issues and updates department materials. Manages care for a panel of high acuity diabetes patients with co-morbidities including assessment, evaluation, education and development of individualized plan of care. Orders and monitors laboratory tests and values. Recommends lifestyle modification. Adjusts medications via Staged Diabetes Management guidelines. Responds to pages from patients, doctors, and Kaiser staff during scheduled hours.
• Documents all care provided to patients. Documents all communications and physician order. Assures clinical record is accurate, legible, and complete. Serves as consultant for other health care team providers regarding diabetes care and management. Participates in patient care conferences with other health care team members to coordinate, discuss and evaluate services provided to patient.
• Educates clinic nurses, clinic staff and non-physician providers in Diabetes and population care management. Coordinates and/or participates in professional development activities that focus on diabetes. Collaborates and communicates with other departments of Kaiser and community resources to coordinate care and services for Kaiser members. Represents Kaiser at appropriate community events. Coordinates and/or participates in department functions such as staff meetings, staff in-services and committees.