Case Manager & Care Coordinator - Maui Lani

Kaiser Permanente; Kahului (HI); On-site; USD 90,000 - 120,000; Full time

Job summary

Kaiser Permanente in Hawaii seeks a registered nurse for case management and outreach to selected patients. Provides discharge planning and follow-up for Health Plan members hospitalized at community facilities; integrates risk, quality and utilization concepts into daily hospital and clinic activities.

The role requires case management/community outreach experience, Hawaii RN license, BLS, and ability to coordinate resources, monitor high-risk members, and communicate effectively with patients

Qualifications

• Minimum one year of healthcare-related case management/outreach experience.
• Bachelor's degree in nursing or four years of related field experience.

Responsibilities

• Provide case management and outreach to targeted patients/families.
• Develop work plans to assist patients in meeting identified needs.
• Coordinate resources to assure continuity and quality of care.
• Monitor high-risk members and assist access to care.
• Assist in discharge planning and smooth transfer to home or alternate facility.
• Participate in interdisciplinary team meetings and maintain confidentiality.

Skills

Case management

Outreach

Discharge planning

Interpersonal relations

Customer service

Communication skills

Education

Bachelor's degree in nursing

4 years related field experience

Tools

Word processing

Spreadsheet

Database

Job description

Job Summary:

Provides case management and outreach services to selected patients. Provides discharge planning services and assists with follow-up for Health Plan members hospitalized at community hospitals. Incorporates Risk Management, Quality Management and Utilization Management concepts into daily hospital and clinic activities.

Essential Responsibilities:

• Implements Continuing Care programs and initiatives with Continuing Care providers and PCP Team. Assists with integrating programs and initiatives into daily practice. Makes clinic/location-specific adaptations as necessary to insure successful implementation of model. Monitors and evaluates outcomes.
• Provides case management services to targeted patients/families by interviewing and evaluating their needs. Develops work plans to assist patients/families in meeting identified needs. Coordinates resources and services to assure continuity and quality of care. Maintains working knowledge of community resources. Interprets Kaiser Permanente benefits/services to patients, families, and members of community.
• Monitors high-risk members and assists them with access to care. Integrates patients into existing programs/services. Evaluates outcomes and makes recommendations for change.
• Assists patients/families with identified problems/concerns.
• Meets with Continuing Care providers and PCP Team to monitor targeted patients. Assists Team by coordinating community care. Explores options to assure that quality, cost-efficient care is provided.
• Makes daily hospital rounds for early identification of UM and discharge planning activities. Assists physician/patient/family in planning discharge. to facilitate smooth transfer to home or alternate facility.
• Reports any Risk/Quality/Utilization Management issues to Neighbor Island Management Team.
• Acts as contact person for MOA/Oahu discharges. Assists patients with smooth transfer to home.
• Participates in community hospital interdisciplinary team meetings.
• Maintains confidentiality of all patient information.
• 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.
• Develops and maintains collegial and consultative working relationship with Government Programs office staff to assure that all regulatory requirements are met and necessary changes are implemented.
• Attends community seminars and workshops specific to professional needs. Participates in approved educational programs.
• Assists in developing, implementing, maintaining, evaluating, and enhancing Total Quality Management activities within organization. Makes suggestions for change/improvement as indicated.
• Incorporates the KP Nursing Vision, Model and Values through out their Nursing Practice.

Basic Qualifications:

Experience

• Minimum one (1) year of working with low income/high risk patients, preferably in healthcare setting, including experience or successful completion of training program (pre-hire, post-hire, or on-the-job) in area of specialty, if applicable.

Education

• Bachelors degree in nursing OR four (4) years of experience in a directly related field.

License, Certification, Registration

• Registered Nurse License (Hawaii) required at hire

• Basic Life Support from American Heart Association

Additional Requirements:

• Case management/community outreach experience.
• Demonstrated knowledge of and skill in oral communication, written communication, interpersonal relations, customer service, change management, multi-task and problem solving.
• Demonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.

Preferred Qualifications:

• Program development and operations level implementation.
• Geriatric experience in outpatient clinic setting.
• Supervisory/lead experience.