Utilization & Discharge RN Case Manager

Kaiser Permanente; Los Angeles (CA); On-site; USD 90,000 - 110,000; Full time

Job summary

Kaiser Permanente is seeking an experienced Registered Nurse to coordinate admissions, screen for medical necessity, and develop safe, cost-effective discharge plans in collaboration with an MD and multidisciplinary team.

The role includes educating patients and families, ensuring timely services, and maintaining compliance with state and federal regulations within a hospital/acute care setting.

Qualifications

• Two (2) years combined RN experience in an acute care setting or case management.
• Completion of an accredited RN training program that allows graduates to take RN license exam.
• Registered Nurse License (California)
• Basic Life Support

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.
• Assesses 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.

Skills

RN experience

Discharge planning

Regulatory knowledge

Education

RN training program

Job description

Kaiser Permanente is seeking an experienced Registered Nurse to coordinate admissions, screen for medical necessity, and develop safe, cost-effective discharge plans in collaboration with an MD and multidisciplinary team.

The role includes educating patients and families, ensuring timely services, and maintaining compliance with state and federal regulations within a hospital/acute care setting.