Coordinator Patient Care - Case Management

Kaiser Permanente; Honolulu (HI); On-site; USD 68,000 - 83,000; Full time

Job summary

Kaiser Permanente in Hawaii is seeking a dedicated Utilization Management professional to coordinate patient care with physicians, staff, and providers. Responsibilities include developing plans of care and discharge plans, reviewing utilization and medical necessity, and guiding care pathways across the care continuum.

The role requires experience in utilization review or acute care nursing, strong collaboration with multidisciplinary teams, and a focus on cost-effective care and regulatory

Qualifications

• Minimum two (2) years of experience in utilization review, case management, transitional care, and discharge planning OR two (2) years of acute care nursing in a hospital setting within the last five (5) years.
• Regulatory knowledge of Medicare/health plan benefits is preferred.
• Strong ability to collaborate with physicians, families, and multidisciplinary teams.

Responsibilities

• Coordinate with physicians, staff, and providers regarding patient care.
• Develop plans of care and discharge plans with physicians.
• Perform utilization reviews to determine medical necessity and appropriate levels of care.
• Educate healthcare team members on utilization and cost containment.
• Monitor progress of care plans and document guidelines and care paths.

Skills

Utilization review

Case management

Discharge planning

Nursing background

Education

Bachelor's degree in nursing or related health care field

High School Diploma or GED

Job description

Job Summary Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care. In conjunction with physicians, develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care.

• The primary job duties this position is responsible for achieving are listed in order of importance.
• Performs daily pre-admission, admission, and concurrent utilization reviews to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved immediately. Performs rounds and reviews patient admissions under Kaiser Skilled Nursing Facility (SNF) benefit. Utilizes knowledge and experience of Medicare regulations and Health Plan benefits to determine medical necessity. Monitors the progression of the plan of care and facilitates discussions with the multidisciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives. Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Issues denial/notices of non-coverage letters after conferring with physicians.
• Ensures continuity of care for outside services for the patient. Monitors level of care. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies.
• Monitors care processes and participates in the development and implementation of guidelines, pre-printed physician orders, care paths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Establishes and maintains effective relationships between Kaiser Permanente and the community facilities. Identifies quality improvement and relationship building opportunities. Monitors high-cost cases and reports findings to Hospital Administration, Director of Continuing Care and/or Community Medical Services. Keeps abreast of current changes in health care benefits, laws or regulatory requirements which influence health plan benefit issues.
• 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.
• Provides direct patient care on an as needed basis. Provides services that are within scope of license and in compliance with all legal, regulatory, and policy requirements relevant to clinical role performed.
• Incorporates the KP Nursing Vision, Model and Values throughout their Nursing Practice.

Job Summary Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care. In conjunction with physicians, develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care.

Essential Responsibilities

• The primary job duties this position is responsible for achieving are listed in order of importance.
• Performs daily pre-admission, admission, and concurrent utilization reviews to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved immediately. Performs rounds and reviews patient admissions under Kaiser Skilled Nursing Facility (SNF) benefit. Utilizes knowledge and experience of Medicare regulations and Health Plan benefits to determine medical necessity. Monitors the progression of the plan of care and facilitates discussions with the multidisciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives. Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Issues denial/notices of non-coverage letters after conferring with physicians.
• Ensures continuity of care for outside services for the patient. Monitors level of care. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies.
• Monitors care processes and participates in the development and implementation of guidelines, pre-printed physician orders, care paths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Establishes and maintains effective relationships between Kaiser Permanente and the community facilities. Identifies quality improvement and relationship building opportunities. Monitors high-cost cases and reports findings to Hospital Administration, Director of Continuing Care and/or Community Medical Services. Keeps abreast of current changes in health care benefits, laws or regulatory requirements which influence health plan benefit issues.
• 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.
• Provides direct patient care on an as needed basis. Provides services that are within scope of license and in compliance with all legal, regulatory, and policy requirements relevant to clinical role performed.
• Incorporates the KP Nursing Vision, Model and Values throughout their Nursing Practice.

Experience

Basic Qualifications

• Minimum two (2) years of experience in utilization review, case management, transitional care, and discharge planning OR two (2) years of acute care nursing (e.g. med/surg, telemetry, ICU, Emergency Room or Orthopedics) in a hospital setting within the last five (5) years.
• Per the National Agreement, current KP Coalition employees have this experience requirement waived.

Education

• Bachelors degree in nursing or other related health care field; or four (4) years of directly related or acute care nursing (e.g., med/surg, telemetry, ICU, Emergency or Orthopedics) hospital experience.
• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• Registered Nurse License (Hawaii)
• Basic Life Support from American Heart Association

Additional Requirements

• Demonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.
• strong organizational skills and multi-tasking abilities.
• Analytical and interpretive ability of data in daily operations.
• Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications

• Demonstrated knowledge and understanding of CMS guidelines, Medicare and Medicaid rules and regulations.
• Community health, home health or skilled nursing care experience.
• Masters Degree in health care administration, nursing, or related field.
• Preferred Case Manager (CCMA, ACMA, or ANCC).

Primary Location: Hawaii,Honolulu,Moanalua Ancillary Building

Scheduled Weekly Hours: 40

Shift: Variable

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

Working Hours Start: 12:00 AM

Working Hours End: 11:59 PM

Job Schedule: Full-time

Job Type: Standard

Worker Location: Onsite

Employee Status: Regular

Employee Group/Union Affiliation: HNA|OPEIU|OPEIU Local 50

Job Level: Individual Contributor

Department: Moanalua Medical Center - Utilization Management - 1201

Pay Range: $75.88 - $75.88 / year

Travel: No

Work Setting: Onsite

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.

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.