CM Utiliz RN

Kaiser Permanente; Downey (CA); On-site; USD 89,000 - 109,000; Full time

Job summary

Kaiser Permanente in Downey, CA is seeking an RN for Utilization Management to collaborate with physicians and coordinate discharge planning for patients. The role emphasizes cost-effective, quality care and active involvement in interdisciplinary teams.

Responsibilities include reviewing hospital stays, coordinating transfers, and ensuring regulatory compliance while maintaining patient safety and timely services.

Qualifications

• Two years RN experience in acute care or case management.
• Completion of an accredited RN program.
• California RN license and BLS certification.
• Knowledge of utilization review, discharge planning and case management.
• Strong verbal and written communication and problem-solving skills.

Responsibilities

• Plans, develops, assesses and evaluates care provided to members.
• Collaborates with physicians and the multidisciplinary team to implement and document care plans.
• Recommends alternative levels of care and ensures regulatory compliance.
• Assess 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 stays to ensure timely services.
• Coordinates transfer of patients to appropriate facilities and obtains authorizations.
• Performs daily clinical reviews for utilization/quality management.
• Acts as liaison between inpatient facility and referral facilities.
• Educates patients to assist with discharge and coping with illness.
• Reports incidents per protocol; participates in data collection and audits.
• Facilitates care planning rounds and family conferences as needed.
• Participates in committees and other work projects.

Skills

RN experience

Care coordination

Multidisciplinary collaboration

Communication skills

Education

RN licensure in California

Tools

Electronic medical records (EMR)

Utilization management systems

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 pace environment.

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.

Experience

Basic Qualifications:

• 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.
• ase management experience preferred \\
• MS/Tele/Inpatient experience preferred

Notes

• Will be required to work every other weekend and holidays per Union Contract

Primary Location: California,Downey,Downey Medical Center

Scheduled Weekly Hours: 40

Shift: Day

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

Working Hours Start: 08:30 AM

Working Hours End: 05:00 PM

Job Schedule: Full-time

Job Type: Standard

Worker Location: Onsite

Employee Status: Regular

Employee Group/Union Affiliation: B21|AFSCME|SCNSC

Job Level: Individual Contributor

Department: Downey Medical Center - Utilization Management - 0801

Pay Range: $64.74 - $79.23 / 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: No

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.