Case Manager Specialist RN - OB/GYN

Kaiser Permanente; Vista (CA); On-site; USD 113,000 - 139,000; Full time

Job summary

Kaiser Permanente in California, Vista, seeks an RN with strong case management and care coordination skills to manage chronic disease patients. You will collaborate with physicians and a multidisciplinary team to develop and implement individualized care plans, monitor outcomes, and coordinate access to services while ensuring regulatory compliance and patient education.

The role emphasizes promoting self-management, coordinating with external providers, and maintaining detailed records to

Qualifications

• Two years clinical RN experience minimum.
• State RN license (California) and Basic Life Support prefered.
• Ability to utilize utilization review/management principles and case management practices.

Responsibilities

• Evaluate and identify members' needs.
• Interface with PCPs, specialists, and disciplines to develop case management plans.
• Monitor and modify case management plans for effectiveness.
• Coordinate continuity of care including utilization management, transfer coordination, discharge planning, and authorizations for outside services.
• Serve as clinical liaison with outside agencies and third party administrators.
• Prepare reports and develop protocols in line with regulations.
• Advise patients and families to empower participation in the care plan.
• Develop patient/family education focused on self-management.
• Provide referrals for services and facilitate transportation/housing as needed.
• Maintain accurate care records and interpret health plan benefits and policies.

Skills

RN clinical experience

Collaboration

Care coordination

Regulatory knowledge

Education

Bachelor's degree in nursing

Equivalent four years experience

BSN or healthcare field preferred for High Risk Infant Program

Job description

Job Summary

Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify member needs and development of specific care management plan to address needs. In conjunction with the Physician, implements care/treatment plan by coordinating access to health services across multiple providers/disciplines, monitors care, makes determination to arrange transportation and transfer patient if indicated, identifies cost‑effective measures, makes recommendations for alternative levels of care and utilization of resources, promotes self‑care management and ensures paper work is completed. Is an indirect caregiver. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.

• Evaluates and identifies members needs.
• Interfaces with Primary Care Physicians, Specialists and various disciplines on the development of case management plans/programs.
• Monitors and evaluates the effectiveness of the case management plans and modifies as necessary.
• 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.
• Acts as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers compensation carriers and third party administrators.
• Prepares reports, communicates program changes to appropriate staff and develops protocols in accordance with state regulations.
• Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care.
• Develops individualized patient/family education plan focused on self-management, delivers patient/family education specific to a disease state.
• Develops and updates training and educational materials and presents to appropriate staff, members and families.
• Facilitates patients return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
• Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
• May need to facilitate transportation and housing arrangements for patient.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards.
• Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service.
• Ensures that accurate records are maintained of the care associated with each patient.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.

• Evaluates and identifies members needs.
• Interfaces with Primary Care Physicians, Specialists and various disciplines on the development of case management plans/programs.
• Monitors and evaluates the effectiveness of the case management plans and modifies as necessary.
• 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.
• Acts as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers compensation carriers and third party administrators.
• Prepares reports, communicates program changes to appropriate staff and develops protocols in accordance with state regulations.
• Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care.
• Develops individualized patient/family education plan focused on self-management, delivers patient/family education specific to a disease state.
• Develops and updates training and educational materials and presents to appropriate staff, members and families.
• Facilitates patients return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
• Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
• May need to facilitate transportation and housing arrangements for patient.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards.
• Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service.
• Ensures that accurate records are maintained of the care associated with each patient.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.

Essential Responsibilities

• Evaluates and identifies members needs.
• Interfaces with Primary Care Physicians, Specialists and various disciplines on the development of case management plans/programs.
• Monitors and evaluates the effectiveness of the case management plans and modifies as necessary.
• 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.
• Acts as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers compensation carriers and third party administrators.
• Prepares reports, communicates program changes to appropriate staff and develops protocols in accordance with state regulations.
• Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care.
• Develops individualized patient/family education plan focused on self-management, delivers patient/family education specific to a disease state.
• Develops and updates training and educational materials and presents to appropriate staff, members and families.
• Facilitates patients return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
• Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
• May need to facilitate transportation and housing arrangements for patient.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards.
• Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service.
• Ensures that accurate records are maintained of the care associated with each patient.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.

Experience

Basic Qualifications

• Minimum two (2) years clinical experience as an RN in an acute care or ambulatory care setting required.
• For positions in OB/Gyn: Two (2) years recent (within the past three (3) years) clinical experience in Maternal Child Health, FCC, Ob/Gyn or Womens Health in acute care or ambulatory care.
• Demonstrated knowledge of maternal/fetal medicine, including high risk pregnancies.

Education

• Bachelors degree or
• Equivalent four (4) experience required.
• For positions in High Risk Infant Program: Bachelors degree in nursing or related field required.

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, care coordination, transfer coordination, 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.

Preferred Qualifications

• Case Management Certification or certification in the area of specialty preferred.
• Bachelors degree in nursing or healthcare related field preferred.
• 1 yr recent experience within the last 3 yrs FT equivalent experience in REI, MCH, FCC, OBG or Women's Health in acute or AMB setting
• Current California RN License and AHA BLS Certification Required.

Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

Job Duties

For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:

• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.
• Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.
• Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.

Primary Location: California,Vista,Vista Medical Offices

Scheduled Weekly Hours: 1

Shift: Day

Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun

Working Hours Start: 08:30 AM

Working Hours End: 05:00 PM

Job Schedule: Per Diem

Job Type: Standard

Worker Location: Onsite

Employee Status: Regular

Employee Group/Union Affiliation: B21|AFSCME|SCNSC

Job Level: Individual Contributor

Department: Vista MOB - Obstetrics/Gyn-Reg Clin - 0806

Pay Range: $82.74 - $101.26 / hour

Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data, internal alignment, and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.

Travel: Yes, 75 % of the Time

Work Setting: Onsite

Worker location must align with Kaiser Permanente's Authorized States policy.

Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.