Palliative Care, Inpatient, Case Manager RN-Per Diem

Alliance for Care at Home; California (MO); Hybrid; USD 85,000 - 105,000; Full time

Job summary

Alliance for Care at Home seeks an RN with home health experience to coordinate multidisciplinary patient care and develop comprehensive treatment plans in California. You will monitor outcomes, educate patients and families, and coordinate with physicians and external providers to ensure appropriate care across the continuum.

The role requires strong communication, collaboration, and knowledge of utilization management, discharge planning, and cost-effective care pathways within regulatory

Qualifications

• Minimum one year RN experience in an acute care setting with two years RN experience in licensed home health or hospice.
• California RN license is required, Basic Life Support certification.

Responsibilities

• Plans, develops, assesses and evaluates care provided to members.
• Evaluates and develops baseline medical and psychosocial evaluations and individualized care plans.
• Recommends alternative levels of care and ensures compliance with regulations.
• Develops patient/family education plans focused on self-management and disease-specific education.
• Coordinates care with utilization and quality reviewers and other providers.

Skills

Utilization review

Discharge planning

Case management

Critical thinking

Communication

Collaboration

Education

Bachelor's degree in nursing or healthcare field (preferred)

Tools

Computer literacy

Job description

Job Summary:

Coordinates with physicians, staff, and non-Kaiser providers/facilities regarding patient care/population based management for patients in specifically defined geriatric or other specifically defined patient populations in order to plan and implement a comprehensive, multi-disciplinary approach to manage health conditions, utilization of resources and protocols, patient self-care, implementation and evaluation of treatment plan across the care continuum (primary, secondary, tertiary and continued care). In conjunction with physicians, develops treatment plan, monitors care, makes recommendations for alternative levels of care, identifies cost-effective protocols and care paths and develops guidelines for care that may require coordination across systems of multiple providers/services. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.

Essential Responsibilities:

• Plans, develops, assesses and evaluates care provided to members.
• In conjunction with primary care and specialist physicians, evaluates and develops baseline medical and psychosocial evaluations and individualized patient care/treatment plans.
• Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
• Develops individualized patient/family education plan focused on self-management; delivers patient/family education specific to a disease state.
• Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy).
• Coordinates care/services with utilization and/or quality reviewers and monitors level and quality of care.
• 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.
• Makes referrals to appropriate community services and outside providers.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment, hospitalization or referral to support services or placement.
• Arranges and monitors follow-up appointments.
• Coordinates repatriation of patients and monitors their quality of care.
• Develops and collects data; trends utilization of health care resources.
• Produces population based reports on outcomes specific to defined patient populations.
• Participates with healthcare team/providers in actualizing outcomes by planning, evaluating and implementing decisions and strategies to achieve predetermined cost, clinical, quality, utilization and service outcomes.
• Develops and maintains case management policies and procedures.
• Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
• Acts as liaison for outside agencies, non-plan facilities, and outside providers.
• Participates in committees, teams or other work projects/duties as assigned.

Basic Qualifications:Experience

• Minimum one (1) year clinical experience as an RN in an acute care setting, plus two (2)years clinical experience as an RN in a licensed home health or hospice agency required.

Education

• N/A

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 required.
• Computer literacy skills required.

Preferred Qualifications:

• Case Management Certification preferred.
• For positions in Special Needs & Care Programs (Care Plus/Guidance): Ambulatory Case Management experience preferred.
• Bachelors degree in nursing or healthcare related field preferred.

Notes:

• Must be available occasional weekends