Description : Job Summary :
Coordinates with physicians, staff and non-Kaiser providers and facilities regarding patients transitions and discharge planning.
In conjunction with physicians, develops plans of care and discharge plans, and makes recommendations for alternative levels of care as required.
Essential Responsibilities :
- Utilization Management : Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies / procedures, and other information to determine appropriate levels of care and readiness for discharge.
- Monitors the progression of the discharge plan and facilitates discussions with the multidisciplinary teams.
- Educates other healthcare team members on utilization and care coordination.
- Collaborates with and provides information to patients, families, physicians, and staff regarding the discharge plans and transitions.
- Understands and consistently applies the interpretation, and utilization of member health care benefits.
- Conducts UM, care coordination and discharge planning activities according to all applicable regulatory requirements.
- Discharge Planning : Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations / approvals as needed for outside services for the patient.
- Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient / family, physician, nursing, social services, and other health care providers and agencies.
- Regulatory : Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements.
- Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status.
Such changes are generally implemented only after notice is given to affected employees.
Basic Qualifications : Experience
Minimum four (4) years of experience in hospital patient care delivery, OR completion of Masters degree in case management program in lieu of minimum years of experience.
Education
- Graduate of accredited school of nursing.
- Diploma / Associate Degree Nursing.
License, Certification, Registration
- Registered Nurse License (California)
- Basic Life Support
Additional Requirements :
- Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all other applicable federal / state / local laws & regulations.
- Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
- Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations.
- Knowledge of health care benefits associated with various business line (Medicare / KPSA, Commercial / KFH, Medi-Cal, Federal, etc.).
- Must be able to work in a Labor / Management Partnership environment.
Preferred Qualifications :
- Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
- Bachelors degree in nursing or a health care related field preferred.
- Masters degree in case management preferred.
Patient Care Coordination Case Manager Short Hour
Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Educates other healthcare team members on utilization ...
Assistant Patient Care Manager (RN) - Imaging Services - (Full-Time, 10-Hour Day Shifts)
Typically assigned responsibility for supervising patient care staff and operations for an assigned shift for a patient care unit(s) and/or for coordinating one or more administrative functions as assigned by the Patient Care Manager, ensuring consistent implementation and monitoring of organization...
Patient Care Coordinator/Case Manager-Santa Clara Discharge Planning (Day/24)
Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Educates other healthcare team members on utilization ...
Assistant Patient Care Manager - Medical Transport, Neonatal Critical Care (1.0 FTE, Days)
The Assistant Patient Care Manager is responsible for assisting the Patient Care Manager with clinical management and administrative coordination of a designated patient care unit(s) or service(s). Assistant Patient Care Managers differ from Patient Care Managers in that the latter are unit managers...
Assistant Patient Care Manager (RN), Neurology
Typically assigned responsibility for supervising patient care staff and operations for an assigned shift for a patient care unit(s) and/or for coordinating one or more administrative functions as assigned by the Patient Care Manager, ensuring consistent implementation and monitoring of organization...
Licensed Mental Health IOP Therapist/Case Manager - Fremont - 38 hours
This is a split Case Management/Intensive Outpatient position. Knowledge of social service agencies, state regulations, and professional board standards as is related to member treatment, patient rights, and member/patient confidentiality. Previous post license, experience as a member of a psychiatr...
Patient Care Manager (RN), GI Oncology – Palo Alto & Redwood City
Clinical Practice: Ensures the effective delivery of competent, compassionate, and efficient patient care by planning, organizing, and directing the nursing services of unit(s), including the assessment of patients, implementation of physicians' orders, treatment plans and medical procedures, admini...
CASE MANAGER (RN) - Case Management / Emergency Department - Full-time (1.0 FTE), 10-hr. Nights *** $10,000 Signing Bonus ***
A Case Manager differs from other roles in professional nursing/health care practice in that it is not intended to provide direct patient care; rather, a Case Manager will be assigned to specific patients to ensure that the medical services and treatments required are accomplished in the most financ...
Assistant Patient Care Manager (RN), Adult Emergency Department (Level 1 Trauma Center) - Evenings
Typically assigned responsibility for supervising patient care staff and operations for an assigned shift for a patient care unit(s) and/or for coordinating one or more administrative functions as assigned by the Patient Care Manager, ensuring consistent implementation and monitoring of organization...
Assistant Contact Center Manager (Specialty Patient Access) Full Time Days (08-HR)
Coordinate for Me: Own the complexity of my care through coordination. Day - 08 Hour (United States of America). This is a Stanford Health Care job. The Assistant Contact Center Manager (ACCM) acts as primary liaison between clients and contact center. ...