Case Manager Outside Utilization RN

Kaiser Permanente Los Angeles , CA 90009

Posted 2 months ago

Description:

Coordinates continuing care/outside services for continuing care members at one medical center. Repatriate stable Kaiser Permanente members from non-Kaiser Permanente facilities in the emergency department and admitted patients.

The process involves screening for appropriateness of care and talking to the outside physician to establish stability to transfer to a Kaiser Permanente facility. Works with KFH and SCPMG staff in developing service plans, providing quality care, cost effective services that are aligned with federal, state and local regulations and continuing care business goals/objectives. Complies with other duties as described.

Essential Responsibilities:

Coordinates the administration and delivery of assigned outside services at one medical center.

Collaborates with physicians, service directors, and other health care providers to identify and implement innovative models and best practices, emphasizing service improvements and cost reduction.

Develops and implements quality and utilization standards to ensure coordinated plans of treatment, customer focused delivery of services and cost effective utilization of necessary services.

Ensures compliance with administrative, legal and regulatory requirements of the Health Plan contract and governmental regulatory and accrediting agencies.

Develops and enhances unit based standards as identified by regulatory agencies.

Provides services that meet standards for customer satisfaction with emphasis on customer service, quality and innovation.

Acts as liaison with non-plan providers.

Develops and expands relationships with contractors/providers.

Utilizes research data to implement service changes and improve the delivery of patient care and member outside services.

Identifies and recommends opportunities for cost savings and improving the quality of care and service.

Participates in committees, teams or other work projects/duties as assigned.

Basic Qualifications:

Experience

Minimum two years clinical experience as an RN in Acute Care or case management required.

Education

Please refer to Minimum Work Experience and Qualifications Sections.

License, Certification, Registration

Current California RN license required.

Additional Requirements:

Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques, and methods of utilization review/management, discharge planning and 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. Computer literacy skills required.

Preferred Qualifications:

Bachelor's degree in nursing or healthcare related field preferred.Consistently demonstrate the knowledge, skills, abilities and behaviors to provide professional, superior, and culturally sensitive service and information to each other, members and to customers, contracted providers and vendors. Able to perform problem resolution, customer follow-up, escalation to administration as required and multi-tasking with various responsibilities such as phone activity with data entry.

Notes:

This is a position with an option of variable hours and shifts rotating w/in the hours of 8:30 am to 8 pm with 8 hours (5 days/week) to 10 hours (4 days//week). Located at Robertson Admin -WLA 3000 S Robertson Blvd LA, CA 90034. Perform other related duties as maybe assigned.

Primary Location: California,Los Angeles,Robertson Administration 3000 S.

Robertson Blvd. Scheduled Weekly Hours: 40 Shift: Day Workdays:

Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: 8:30 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status:

Regular Employee Group/Union Affiliation: SCNSC Job Level: Individual Contributor Job Category:

Nursing Licensed Specialty: Continuing Care (Home Health / Hospice / SNF) Department: KP Reconnect Travel:

No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

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Case Manager Outside Utilization RN

Kaiser Permanente