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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.

Transplant Coordinator (Part Time - Day)

Location: Oakland, CA Job Number: 700630 Date posted: 05/16/2018
Description: This position provides case management for patients with end stage organ disease referred for transplantation. This position facilitates pre- and post-transplant care for patients through face to face or telephonic interventions; providing, facilitating, and coordinating support for transplant program initiatives, as well as education and training for both patients and providers. The position is responsible for managing outside medical costs and effectively utilizing internal resources. This position will provide case management coverage for the transplant types managed by one of the three transplant Hubs. It also includes a rotation of on-call responsibility(24/7) with other RN staff within the NTS. Some travel may be required. Position responsible for providing float coverage across the transplant areas managed by the Hub to ensure members receive quality care, cost effectively and efficiently.

Essential Responsibilities:
  • Coordinates case management to include, but not limited to, continuity of care, inpatient and outpatient care, utilization management, transfer coordination, discharge planning, travel and lodging needs, patient and family education specific to transplant related care and in-patient concurrent review.
  • Facilitates an effective and efficient case management process that integrates a multitude of services together to ensure that a comprehensive system for care is in place, where patients are appropriately managed through the continuum of care, resources both internally and externally are appropriately utilized and successful outcomes are achieved.
  • Utilizes the nursing process to identify barriers to care and select appropriate solutions from potential options for intervention, based on a set of complex and individual patient needs. This includes identifying cultural and linguistic needs and incorporating actions to address such needs in the case management plan. Must also be able to provide age appropriate care. Employees exhibit problem-solving skills to overcoming hurdles that may be identified. Decisions must be made relative to patient goal identification and achievement, as well as resources required to meet the needs of the patient. Works independently within the scope of nursing practice and organization policies in the management of caseload assigned. Appropriately triages patient calls, provider calls both internally and from transplant centers when performing On-Call responsibility.
  • Identifies, reports, and monitors quality of care issues, trends and events as well as other information on the key elements of the quality program occurring both internally and within Centers of Excellence that relate to the delivery of care to transplant patients. Participates in performance improvement initiatives.
  • Maintains current knowledge in the field of transplantation and integrates this knowledge into the assessment of needs and problem solving required to manage across the continuum.
  • Establishes and maintains effective partnerships between KP and Centers of Excellence with the goal of providing total quality and case management for KP members receiving transplant services.
  • Assists in development and maintenance of educational materials for the KP transplant program, including but not limited to, information for members, families, physicians, and Centers of Excellence. Position may participate in operational and educational meetings with Centers of Excellence and KP Regions. Some travel may be required.

  • Basic Qualifications:
  • Minimum three years of experience in critical care emergency care general medical/surgical services or utilization management and/or discharge planning.
  • Minimum three years experience in clinical transplant services or case management (disease management, population management, chronic disease management, complex case management).
  • Minimum three years experience using evidence-based practice.
  • Minimum three years organizing a large patient case load (15 patient for outpatient, 6 for inpatient).
  • Minimum three years experience in an individual contributor role in healthcare.
  • Bachelor's degree in Nursing OR a Master's in Nursing is required.
    License, Certification, Registration
  • BSN
  • Active, valid and unrestricted registered nurse license in the state where care is provided.

    Additional Requirements:
  • Must be able to work in a Labor/Management Partnership environment.

    Preferred Qualifications:
  • Two years SolidOrgan Transplant or Bone Marrow Transplant experience.
  • Experience in Cardiology, Pulmonology, GI/Hepatology, Nephrology or Hematology and/or Oncology services as applicable to the specific transplant service.
  • Two years experience working with health plan operations (Medicare, Medicaid, Commercial insurance benefits and coverage, authorizations and denials. Two years experience interfacing within an electronic record environment.
  • Preferred Certifications: Certification in clinical transplant coordination (CCTC, ITNS) or case management (CCM) preferred.

    Primary Location: California,Oakland,1800 Harrison 1800 Harrison Scheduled Weekly Hours: 20 Shift: Day Workdays: Mon - Fri Working Hours Start: Variable Working Hours End: Variable Job Schedule: Part-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Non-Union, Non-Exempt Job Level: Individual Contributor Job Category: QA / UR / Case Management Department: National Transplant Services 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.
  • About QA, Ur & Case Management Careers

    Careers In QA, Ur & Case Management

    As an organization, we are committed to delivering the same exemplary care no matter who you are, where you are, or what your needs. But how are those standards defined, measured, and assessed? That's where our quality assurance team comes in. Implementing the action plans and initiatives that will drive successful practices, you'll work across the organization to foster the necessary education, communication, and innovation that will enable us to operate as one KP — with our mission and goals in complete alignment.

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