Coordinator Patient Care – Case Management, PD Day

KAISER; Honolulu (HI); On-site; USD 90,000 - 110,000; Full time

Job summary

Kaiser Permanente in Honolulu is seeking a nursing professional to coordinate patient care with physicians and staff, develop plans of care and discharge plans, and monitor clinical activities. You will identify cost-effective protocols and guide care within regulatory guidelines while collaborating with the care team and families to ensure quality outcomes.

Responsibilities include reviewing admissions, determining medical necessity, educating team members on cost containment, and communicating

Qualifications

• Utilization review experience and knowledge of Medicare regulations.
• Ability to educate healthcare teams on utilization and cost containment.
• Collaboration with patients, families, physicians, and staff regarding care provisions.
• Ability to issue denial/notices of non-coverage after conferring with physicians.

Responsibilities

• Coordinate with physicians, staff, and other providers regarding patient care.
• Perform daily pre-admission, admission, and concurrent utilization reviews to determine care levels and discharge readiness.
• Monitor the plan of care progression and facilitate multidisciplinary discussions.
• Develop discharge plans with patients and families, physicians, and social services.
• Develop and implement care guidelines, orders, and care paths; identify opportunities for cost savings and quality improvements.
• Maintain relationships with Kaiser Permanente and community facilities; monitor high-cost cases and report findings.

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.

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.