Case Manager Utilization RN, 40/hr Day V Ventura

Kaiser Permanente; Los Angeles (CA); On-site; USD 100,000 - 130,000; Full time

Job summary

Kaiser Permanente in Los Angeles seeks an experienced Registered Nurse to coordinate admissions, screen for medical necessity, and develop safe discharge plans with the MD and multidisciplinary team.

You will advocate for patients, facilitate utilization management, and ensure compliance with TJC and state regulations while maintaining cost-effective care. An active CA RN license and BLS are required; two years of acute care or case management experience preferred.

Qualifications

• Demonstrated ability to utilize/apply Utilization review/management
• Strong discharge planning and case management skills
• Effective written and verbal communication, critical thinking and problem-solving abilities
• Computer literacy and ability to plan, organize and negotiate effectively

Responsibilities

• Plans, develops, assesses and evaluates care for members.
• Collaborates with physicians and multidisciplinary team to create and document plans of care.
• Recommends alternative levels of care and ensures regulatory compliance.
• Assesses high-risk patients for post-hospital care planning.
• Develops and coordinates discharge plans to meet patient needs.
• Communicates the plan to physicians, patients, families and community agencies.
• Monitors and coordinates hospital stay to ensure timely services.
• Acts as liaison between inpatient and referral facilities; provides case management.

Skills

Utilization review

Discharge planning

Case management

Communication

Critical thinking

Problem solving

Planning

Organization

Negotiation

Computer literacy

Education

RN program

Job description

Job Summary:

Works 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 paceenvironment.

Essential Responsibilities:

• Plans, develops, assesses and evaluates care provided to members.
• Collaborates 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.
• Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
• Assess high risk patients in need of post-hospital care planning.
• Develops 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.
• Reviews, monitors, evaluates and coordinates the patients hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
• Participates in the Bed Huddles and carries out recommendations congruent with the patients needs.
• Coordinates 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.
• Conducts 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.
• Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
• Refers patients to community resources to meet post hospital needs.
• Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation.
• Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOL.
• Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
• Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
• Per 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.
• Reviews, 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.
• Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed.
• Participates in committees, teams or other work projects/duties as assigned.

Basic Qualifications:

Experience

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

Education

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

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.
• Demonstrated ability in planning, organizing, conflict resolution and negotiating skills.
• Computer literacy skills required.

Preferred Qualifications:

• Bachelors degree in nursing or healthcare related field.

Notes:

• Inpatient CM cross trained to ED
• If ten (10) hour option chosen, shift will be 8:00 am-6:30 pm, back up 8 hour shift will be 7:00 am to 3:30 pm.