Case Manager Continuing Care Coord RN (Bilingual Spanish)

Kaiser Permanente; Los Angeles (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

Kaiser Permanente in Los Angeles is seeking an experienced RN for geriatric and population-based care management. You will collaborate with physicians and a multidisciplinary team to plan and implement comprehensive care and coordinate across the care continuum.

You will develop individualized care plans, monitor outcomes, ensure compliance with regulatory standards, and support patient self-management while coordinating transitions and referrals within Kaiser facilities and partner providers.

Qualifications

• Two years of RN clinical experience in an acute care setting required.
• Bilingual (English/Spanish) Level II required.
• Basic Life Support certification.

Responsibilities

• Plans, develops, assesses and evaluates care for members.
• Evaluates and develops baseline medical and psychosocial care plans with physicians.
• Recommends alternative levels of care and ensures regulatory compliance.
• Develops patient/family education focused on self-management.
• Encourages adherence to prescribed treatments.
• Coordinates care with utilization and quality reviewers.
• Facilitates continuity of care across care continuum.
• Arranges follow-up appointments and coordinates referrals.
• Coordinates information transmission to patients and external providers.
• Participates in multidisciplinary teams and committees.

Skills

Clinical experience

Bilingual English/Spanish

Education

Nursing degree

Job description

Job Summary:

Coordinates with physicians, staff, and non-Kaiser providers/facilities regarding patient care/population based management for patients in specifically defined geriatric or other specifically defined patient populations in order to plan and implement a comprehensive, multi-disciplinary approach to manage health conditions, utilization of resources and protocols, patient self-care, implementation and evaluation of treatment plan across the care continuum (primary, secondary, tertiary and continued care). In conjunction with physicians, develops treatment plan, monitors care, makes recommendations for alternative levels of care, identifies cost-effective protocols and care paths and develops guidelines for care that may require coordination across systems of multiple providers/services. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.

Essential Responsibilities:

• Plans, develops, assesses and evaluates care provided to members.
• In conjunction with primary care and specialist physicians, evaluates and develops baseline medical and psychosocial evaluations and individualized patient care/treatment plans.
• Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
• Develops individualized patient/family education plan focused on self-management; delivers patient/family education specific to a disease state.
• Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy).
• Coordinates care/services with utilization and/or quality reviewers and monitors level and quality of care.
• Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
• Makes referrals to appropriate community services and outside providers.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment, hospitalization or referral to support services or placement.
• Arranges and monitors follow-up appointments.
• Coordinates repatriation of patients and monitors their quality of care.
• Develops and collects data; trends utilization of health care resources.
• Produces population based reports on outcomes specific to defined patient populations.
• Participates with healthcare team/providers in actualizing outcomes by planning, evaluating and implementing decisions and strategies to achieve predetermined cost, clinical, quality, utilization and service outcomes.
• Develops and maintains case management policies and procedures.
• Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
• Acts as liaison for outside agencies, non-plan facilities, and outside providers.
• Participates in committees, teams or other work projects/duties as assigned.

Basic Qualifications:

Experience

• Two (2) years clinical experience as an RN in an acute care setting required.

Education

• N/A

License, Certification, Registration

• Registered Nurse License (California)
  

• Basic Life Support
  

Additional Requirements:

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

• Bilingual (English/Spanish) Level II required.

Preferred Qualifications:

• Case Management Certification preferred.

• Bachelors degree in nursing or healthcare related field preferred.

• Ambulatory Case Management experience preferred.

Notes:

• Must successfully pass or have passed the bilingual test (within the last 12 months), or be active in the QBS program