Case Manager Utilization Rn

Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a safe and acceptable discharge plan. Functions as an indirect caregiver, patient advocate and manages patients in the most cost effective way without compromising quality. Transfers stable non-members to planned Health care facilities. Responsible for complying with AB 1203, Post Stabilization notification. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team, multitask and in a fast pace environment.

• Participates in committees, teams or other work projects/duties as assigned.
• 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.
• Assesses high risk patients in need of post-hospital care planning.
• Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
• 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.
• 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.
• 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.
• Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed.
• Reviews, monitors, evaluates and coordinates the patients hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
• 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.
• 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.
• Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation.
• Participates in the Bed Huddles and carries out recommendations congruent with the patients needs.
• Plans, develops, assesses and evaluates care provided to members.
• Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
• Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
• Develops and coordinates the implementation of a discharge plan to meet patients identified needs.
• Communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies.

• Two (2) years combined RN experience in an acute care setting or case management required.

• Completion of an accredited RN training program that allows graduates to take RN license exam.

• Registered Nurse License (California)

• Basic Life Support

• Computer literacy skills required.
• Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
• Demonstrated ability in planning, organizing, conflict resolution and negotiating skills.
• Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.
• Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills.

• Bachelors degree in nursing or healthcare related field.

Notes:

• Rotating weekends

PrimaryLocation : California,Baldwin Park,Baldwin Park Medical Offices
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri, Sat, Sun
WorkingHoursStart : 07:00 AM
WorkingHoursEnd : 03:30 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : B21|AFSCME|SCNSC
Job Level : Individual Contributor
Job Category : QA, UR & Case Management
Department : Baldwin Park Med Center - Utilization Management - 0801
Travel : No
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.