Kaiser Permanente
Case Management Utilization RN, 24/hr Day
Kaiser Permanente, Los Angeles, California, United States, 90079
Job Summary
Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and continued stays. Provides recommendations to physicians for alternate levels of care when patients do not meet medical necessity for inpatient hospitalization. Interacts with family, patient, and disciplines to coordinate a safe and acceptable discharge plan. Functions as indirect caregiver, patient advocate, ensuring cost‑effective management without compromising quality. Transfers stable non‑members to planned health‑care facilities. Complies with AB 1203 Post Stabilization notification. Must collaborate with a multidisciplinary team, multitask in a fast‑paced environment.
Essential Responsibilities
Plans, develops, assesses, and evaluates care provided to members.
Collaborates with physicians, the multidisciplinary health‑care team, and patient/family in developing, implementing, and documenting individualized plans of care.
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 discharge plans to meet identified patient needs.
Communicates the plan to physicians, patient, family/caregivers, staff, and community agencies.
Monitors and coordinates patients’ hospital stay to assure timely delivery of essential services.
Participates in Bed Huddles and implements recommendations congruent with patient needs.
Coordinates interdisciplinary approach to continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations/approvals for outside services.
Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards across multiple settings.
Acts as liaison between inpatient facility and referral agencies; provides case management to referred patients.
Refers patients to community resources to meet post‑hospital needs.
Maintains required documentation for patient transfer.
Adheres to internal and external regulatory and accreditation requirements and guidelines (TJC, DHS, HCFA, CMS, DMHC, NCQA, DOL).
Educates healthcare team on discharge planning process and appropriate use of resources.
Provides patient education to assist discharge and cope with psychological issues related to acute/chronic illness.
Reports any unusual incidents related to quality, risk, or patient safety as per established protocols.
Analyzes utilization patterns and trends; contributes to data for special studies, projects, and routine monitoring.
Facilitates care‑planning rounds and patient family conferences when needed.
Participates in committees and other work projects as assigned.
Basic Qualifications
Two (2) years combined RN experience in acute‑care setting or case management required.
Completion of an accredited RN training program that allows graduation for RN license exam eligibility.
Registered Nurse License (California).
Basic Life Support certification.
Demonstrated ability to utilize utilization review/management, discharge planning or case management principles.
Working knowledge of regulatory requirements and accreditation standards.
Strong written and verbal communication, interpersonal, critical thinking, and problem‑solving skills.
Planning, organizing, conflict resolution, and negotiation skills.
Computer literacy required.
Preferred Qualifications
Bachelor’s degree in nursing or a healthcare‑related field.
Additional Information
Rotating weekends (Saturday and Sunday).
May be rotated to ED or inpatient.
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Essential Responsibilities
Plans, develops, assesses, and evaluates care provided to members.
Collaborates with physicians, the multidisciplinary health‑care team, and patient/family in developing, implementing, and documenting individualized plans of care.
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 discharge plans to meet identified patient needs.
Communicates the plan to physicians, patient, family/caregivers, staff, and community agencies.
Monitors and coordinates patients’ hospital stay to assure timely delivery of essential services.
Participates in Bed Huddles and implements recommendations congruent with patient needs.
Coordinates interdisciplinary approach to continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations/approvals for outside services.
Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards across multiple settings.
Acts as liaison between inpatient facility and referral agencies; provides case management to referred patients.
Refers patients to community resources to meet post‑hospital needs.
Maintains required documentation for patient transfer.
Adheres to internal and external regulatory and accreditation requirements and guidelines (TJC, DHS, HCFA, CMS, DMHC, NCQA, DOL).
Educates healthcare team on discharge planning process and appropriate use of resources.
Provides patient education to assist discharge and cope with psychological issues related to acute/chronic illness.
Reports any unusual incidents related to quality, risk, or patient safety as per established protocols.
Analyzes utilization patterns and trends; contributes to data for special studies, projects, and routine monitoring.
Facilitates care‑planning rounds and patient family conferences when needed.
Participates in committees and other work projects as assigned.
Basic Qualifications
Two (2) years combined RN experience in acute‑care setting or case management required.
Completion of an accredited RN training program that allows graduation for RN license exam eligibility.
Registered Nurse License (California).
Basic Life Support certification.
Demonstrated ability to utilize utilization review/management, discharge planning or case management principles.
Working knowledge of regulatory requirements and accreditation standards.
Strong written and verbal communication, interpersonal, critical thinking, and problem‑solving skills.
Planning, organizing, conflict resolution, and negotiation skills.
Computer literacy required.
Preferred Qualifications
Bachelor’s degree in nursing or a healthcare‑related field.
Additional Information
Rotating weekends (Saturday and Sunday).
May be rotated to ED or inpatient.
#J-18808-Ljbffr