Hospital Case Manager; FT40, MMMC

Job description

Job Summary:

nCoordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care. In conjunction with physicians, develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care.

nEssential Responsibilities:

nnnPerforms daily pre-admission, admission, and concurrent utilization reviews to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved immediately. Performs rounds and reviews patient admissions under Kaiser Skilled Nursing Facility (SNF) benefit. Utilizes knowledge and experience of Medicare regulations and Health Plan benefits to determine medical necessity. Monitors the progression of the plan of care and facilitates discussions with the multidisciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives. Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Issues denial/notices of non-coverage letters after conferring with physicians.

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nnEnsures continuity of care for outside services for the patient. Monitors level of care. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies.

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nnMonitors care processes and participates in the development and implementation of guidelines, pre-printed physician orders, care paths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Establishes and maintains effective relationships between Kaiser Permanente and the community facilities. Identifies quality improvement and relationship building opportunities. Monitors high-cost cases and reports findings to Hospital Administration, Director of Continuing Care and/or Community Medical Services. Keeps abreast of current changes in health care benefits, laws or regulatory requirements which influence health plan benefit issues.

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nnMay 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.

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nnProvides 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.

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nnIncorporates the KP Nursing Vision, Model and Values throughout their Nursing Practice.

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n nBasic Qualifications:

nExperience

nnnFour (4) years of acute or sub-acute inpatient care experience.

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nnOne (1) year of Care Management experience OR successful completion of the MHS Case Management Internship within 6 months of hire.

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n nEducation

nnBachelors degree in nursing OR four (4) years of directly related experience.

n nLicense, Certification, Registration

nnnBasic Life Support OR CPR/AED for Professional Rescuers

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nnRegistered Nurse License (Hawaii)

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n nAdditional Requirements:

nnnDemonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.

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nnAnalytical and interpretive ability of data in daily operations.

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n nPreferred Qualifications:

nnnMinimum two (2) years of experience in Care Management.

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nnMasters Degree in health care administration, nursing, or related field.

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nnProfessional certification in Case Management.

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n nCOMPANY: KAISER

nTITLE: Hospital Case Manager; FT40, MMMC

nLOCATION: Wailuku, Hawaii

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

wailuku, HI, 96793, US

Who can apply

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