Kaiser Permanente
Patient Care Coordinator CM (UR-Discharge Planning)
Kaiser Permanente, San Francisco, California, United States, 94199
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, and other information to determine appropriate levels of care and readiness for discharge.
Monitors the progression of the discharge plan and facilitates discussions with multidisciplinary teams.
Educates other healthcare team members on utilization and care coordination.
Collaborates with and provides information to patients, families, physicians, and staff regarding 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, and obtaining authorizations/approvals for outside services.
Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with patient/family, physician, nursing, social services and other health‑care providers and agencies.
Regulatory compliance: conducts UM, care coordination and discharge planning activities according to all applicable regulatory requirements.
Basic Qualifications
Minimum four (4) years of experience in hospital patient care delivery, or completion of a master’s degree in case management in lieu of minimum years of experience.
Education
Graduate of an accredited nursing school.
Diploma or associate degree in nursing.
License, Certification, Registration
Registered Nurse license (California).
Basic Life Support certification.
Additional Requirements
Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPAA, ERISA, EMTALA and all other applicable federal, state, and local laws and regulations.
Demonstrated strong communication and customer service skills, problem‑solving, critical thinking and clinical judgment abilities.
Fundamental word processing and computer navigation skills and the ability to interpret and use analytic data in day‑to‑day operations.
Knowledge of health‑care benefits associated with various business lines (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.
Bachelor’s degree in nursing or a health‑care related field.
Master’s degree in case management.
Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, the company 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.
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Essential Responsibilities
Utilization management: performs daily pre‑admission, admission, and concurrent utilization reviews using guidelines, institutional policies, and other information to determine appropriate levels of care and readiness for discharge.
Monitors the progression of the discharge plan and facilitates discussions with multidisciplinary teams.
Educates other healthcare team members on utilization and care coordination.
Collaborates with and provides information to patients, families, physicians, and staff regarding 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, and obtaining authorizations/approvals for outside services.
Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with patient/family, physician, nursing, social services and other health‑care providers and agencies.
Regulatory compliance: conducts UM, care coordination and discharge planning activities according to all applicable regulatory requirements.
Basic Qualifications
Minimum four (4) years of experience in hospital patient care delivery, or completion of a master’s degree in case management in lieu of minimum years of experience.
Education
Graduate of an accredited nursing school.
Diploma or associate degree in nursing.
License, Certification, Registration
Registered Nurse license (California).
Basic Life Support certification.
Additional Requirements
Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPAA, ERISA, EMTALA and all other applicable federal, state, and local laws and regulations.
Demonstrated strong communication and customer service skills, problem‑solving, critical thinking and clinical judgment abilities.
Fundamental word processing and computer navigation skills and the ability to interpret and use analytic data in day‑to‑day operations.
Knowledge of health‑care benefits associated with various business lines (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.
Bachelor’s degree in nursing or a health‑care related field.
Master’s degree in case management.
Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, the company 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.
#J-18808-Ljbffr