Case Manager Utilization RN, Per Diem Day

Job description

Job Summary:

nWorks 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.

nEssential Responsibilities:

nnnPlans, develops, assesses and evaluates care provided to members.

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nnCollaborates 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.

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nnRecommends alternative levels of care and ensures compliance with federal, state and local requirements.

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nnAssesses high risk patients in need of post-hospital care planning.

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nnDevelops 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.

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nnReviews, monitors, evaluates and coordinates the patients hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.

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nnParticipates in the Bed Huddles and carries out recommendations congruent with the patients needs.

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nnCoordinates 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.

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nnConducts 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.

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nnActs as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.

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nnRefers patients to community resources to meet post hospital needs.

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nnCoordinates transfer of patients to appropriate facilities; maintains and provides required documentation.

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nnAdheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOL.

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nnEducates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.

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nnProvides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.

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nnPer 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.

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nnReviews, 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.

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nnCoordinates, participates and or facilitates care planning rounds and patient family conferences as needed.

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nnParticipates in committees, teams or other work projects/duties as assigned.

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n nBasic Qualifications:

nExperience

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

n nEducation

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

n nLicense, Certification, Registration

nnnRegistered Nurse License (California)

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nnBasic Life Support

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n nAdditional Requirements:

nnnDemonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.

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nnWorking knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).

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nnDemonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills.

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nnDemonstrated ability in planning, organizing, conflict resolution and negotiating skills.

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nnComputer literacy skills required.

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n nPreferred Qualifications:

nnnBachelors degree in nursing or healthcare related field.

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nnRecent Acute Care Experience within 5 years preferred.

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n nCOMPANY: KAISER

nTITLE: Case Manager Utilization RN, Per Diem Day

nLOCATION: Harbor City, California

nREQNUMBER:

nExternal 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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

Worksite address

harbor city, CA, 90710, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.