Inpatient Continuing Care Manager

Job Summary :

The Manager of Inpatient Continuing Care serves as liaison between Kaiser Permanente (KP) Health Plan, MAPMG providers, staff and faculty at hospital facilities, to facilitate open communication and ensure smooth transitions of care between KP and other care delivery systems.

This position is also responsible for supervising and managing teams of personnel who support utilization management, transitions of care and discharge planning activities.

This position ensures compliance with NCQA, state, federal and other regulatory accreditation standards.

Essential Responsibilities :

• Performs as an organizational liaison between Health Plan, MAPMG providers and faculty and staff at facility.
• Promotes relationships and communication between KP members, Health Plan, MAPMG providers and faculty and
• staff at facility.
• Develops collaborative relationships within MAPMG, facility faculty and staff and other KP departments to provide and facilitate transitions of care.
• Manages and directs Patient Care Coordinators and support staff to ensure utilization management and discharge planning activities are applied in a consistent and effective manner.

Oversees day to day activities of assigned staff, to include staff scheduling, caseload assignment, appropriate utilization of resources and timely discharge planning.

• Ensures member benefits are interpreted and applied correctly and in compliance with state and federal regulations.
• Conducts case level reviews and provides feedback to Patient Care Coordinator staff on a regular basis.
• Participates in multidisciplinary rounds. Ensures that transitions of care to alternative levels of care are smooth and
• coordinated with Health Plan, facility, providers and KP member / family.
• Provides support and oversight of UM activities (i.e., use of UM guidelines / criteria and UM processes).
• Partners with other members of the UMOC and Continuing Care teams to develop and implement collaborative
• processes.
• Supports professional growth by providing education, training and appropriate resources.Conducts performance
• evaluations, provides coaching and acts as a mentor to direct reports.
• Performs other related duties as assigned.

Rotating manager on-call requirements

Basic Qualifications :

Experience

• Minimum of five (5) years of experience in a clinical setting.
• Minimum of two (2) of the five (5) years of experience as a Registered Nurse OR in Utilization Management OR Case Management.
• Minimum of two (2) of the five (5) years of supervisory OR as a Kaiser Permanente Patient Care Coordinator experience.

Education

Bachelors degree in nursing, health care administration or related field.

License, Certification, Registration

• This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.
• Registered Nurse License (Virginia) within 6 months of hire AND Registered Nurse License (Maryland) within 6 months of hire
• Compact License : Registered Nurse within 6 months of hire
• Registered Nurse License (District of Columbia) within 6 months of hire
• Basic Life Support from American Heart Association

Additional Requirements :

• Proficient in computer applications including Microsoft Word, PowerPoint and Excel required.
• Strong interpersonal skills, with good verbal and written communication skills required.
• Skills in problem-solving and collaboration with other professions / disciplines required.
• Ability to work comfortably and effectively in a hospital and managed care setting required.

Preferred Qualifications :

• Experience working with various member populations in a community setting.
• Knowledge of KP or other integrated health care delivery system.
• Working knowledge of KP or experience working with state Medicaid / Medicare plans.
• Certification in Case Management from Commission for Case Manager Certification or Nursing Case Manager Certification from American Nurses Credentialing Center.
• Masters degree in nursing, health care administration or related field.
8 days ago