Case Mgr Utilization RN ( Job Number: 180462 )
Location: Escondido California
Description: Kaiser Permanente is employing Case Mgr Utilization RN ( Job Number: 180462 ) right now, this occupation will be placed in California. Detailed specification about this occupation opportunity please give attention to these descriptions. Works collaboratively w/ an MD to coordinate & screen for the appropriateness of admissions & Continued stays. Makes recommendations t! o the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts w/ the family, patient & other disciplines to coordinate a safe & acceptable discharge plan. Functions as an indirect caregiver, patient advocate & manages patients in the most cost effective way w/out compromising quality. Transfers stable non-members to planned Health care facilities. Responsible for complying w/ AB 1203, Post Stabilization notification. Complies w/ other duties as described. Must be able to work collaboratively w/ the multidisciplinary team ,multitask & in a fast pace environment.
Essential Functions:
- Plans, develops, assesses & evaluates care provided to members
- Collaborates w/ physicians, other members of the multidisciplinary health care team & patient/family in the development, implementation & documentation of appropriate, individualized plans of care to ensure continuity, q! uality & appropriate resource use
- Recommends alternat! ive levels of care & ensures compliance w/ fed, state & local requirements
- Assesses high risk patients in need of post-hospital care planning
- Develops & coordinates the implementation of a discharge plan to meet patient's identified needs; communicates the plan to physicians, patient, family/caregivers, staff & appropriate community agencies
- Reviews, monitors, evaluates & coordinates the patient's hospital stay to assure that all appropriate & essential services are delivered timely & efficiently
- Participates in the Bed Huddles & carries out recommendations congruent w/ the patient's needs
- Coordinates the interdisciplinary approach to providing continuity of care, including Utilization mgmt, Transfer coord, Discharge planning, & obtaining all authorizations/approvals as needed for outside services for patients/ families
- Conducts daily clinical reviews for utilization/quality mgmt activities based on guidelines/standards ! for patients in a variety of settings, including outpatient, emergency room, inpatient & non-KFH facilities
- Acts as a liaison between in-patient facility & referral facilities/agencies & provides case mgmt to patients referred
- Refers patients to community resources to meet post-hospital needs
- Coordinates transfer of patients to appropriate facilities; maintains & provides required documentation
- Adheres to internal & external regulatory & accreditation requirements & compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA & DOL
- Educates members of the healthcare team concerning their roles & responsibilities in the discharge planning process & appropriate use of resources
- Provides patients w/ education to assist w/ their discharge & help them cope w/ psychological problems related to acute & chronic illness
- Per established protocols, reports any incidence of unusual occurrences related! to quality, risk and/or patient safety which are identified during cas! e review or other activities
- Reviews, analyses & identifies utilization patterns & trends, problems or inappropriate utilization of resources & participates in the collection & analysis of data for special studies, projects, planning, or for routine utilization monitoring activities
- Coordinates, participates & or facilitates care planning rounds & patient family conferences
- Participates in committees, teams or other work projects/duties as assigned
This position is a SCNSC bargaining unit represented position
Basic Qualifications:
- Minimum of two (2) years clinical experience as an RN in an acute care setting required.
- Bachelor's degree in nursing or healthcare related field preferred.
- Current California RN license required.
- BLS.
- Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utiliza! tion 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.
- Demonstrated ability in planning, organizing, conflict resolution and negotiating skills.
- Computer literacy skills required.
•
Prefer case management experience in a hospital setting.
Notes:
•
Palomar will be primary work site but may need to float to any supplemental/referral facility in San Diego in case of staffing shortages and on weekend rotations.
- .
If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Kaiser Permanente.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Tue, 23 Apr 2013 11:19:34 GMT