Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Case Manager Utilization RN

Expired Job

Kaiser Permanente Moreno Valley , CA 92551

Posted 2 months ago

Description:

Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a safe and acceptable discharge plan. Functions as an indirect caregiver, patient advocate and manages patients in the most cost effective way without compromising quality. Transfers stable non-members to planned Health care facilities. Responsible for complying with AB 1203, Post Stabilization notification. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team, multitask and in a fast pace environment.

Essential Functions:

  • Plans, develops, assesses & evaluates care provided to members.

  • Collaborates with 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, quality & appropriate resource use.

  • Recommends alternative levels of care & ensures compliance with federal, 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 with the patient's needs.

  • Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, & obtaining all authorizations/approvals as needed for outside services for patients/families.

  • Conducts daily clinical reviews for utilization/quality management 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 management 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 with education to assist with their discharge & help them cope with 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 case 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 as needed.

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

Basic Qualifications:

Experience

  • Two (2) years clinical experience as an RN in an acute care setting required.

Education

  • Completion of an accredited RN training program that allows graduates to take RN license exam.

Licenses, Certifications, Registrations

  • Current California RN license required.
  • BLS.

Additional Requirements:

  • Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization 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.

Preferred Qualifications:

  • Bachelor's degree in nursing or healthcare related field preferred.
  • CM experience preferred.
  • ED and/or ICU RN experience preferred if no CM experience.

Notes:

  • Day shift inpatient case manager position.

  • Every third weekend required, holidays required.

  • Will be crossed trained for ED.

Primary Location: California,Moreno Valley,Moreno Valley Community Hospital 27300 Iris Ave. Scheduled Weekly Hours: 32 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: 8:00 AM Working Hours End: 4:30 PM Job Schedule: Part-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: SCNSC Job Level: Individual Contributor Job Category: Nursing Licensed Department: Utilization Management (Case Manager) Travel: No

Click here for additional requirements >


See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Staff RN (Hospital) PdMv

Kaiser Permanente

Posted 3 days ago

VIEW JOBS 11/11/2018 12:00:00 AM 2019-02-09T00:00 Description: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance consistent with the Medical Center Vision, Mission, and Strategic Plan of the organization. Remains flexible to changing systems; is expected to demonstrate quality and effectiveness in work habits and clinical practice; and treats co-workers, patients, families, and all members of the health care team with dignity and respect. Essential Responsibilities: Essential Duties: The Registered Nurse demonstrates proficiency by exhibiting the following skills, competencies, and behaviors: Leadership: Upholds Kaiser Permanente's Policies and Procedures, Principles of Responsibilities, and applicable state, federal and local laws. Serves as a leader of the health care team; delegates tasks appropriately, and demonstrates appropriate accountability. Understands own and team members scope of practice and escalates issues as appropriate. Demonstrates professional, supportive behavior. Champions new ideas. Leads and directs others through the change process. Utilizes communication strategies including chain of command and issue escalation, which result in intended outcomes. Participates in problem identification and resolution. Mentors, orients, and coaches others in unit specific operations and patient care activities Shares responsibility and authority with subordinates and holds him/her accountable for performance. Demonstrates ability to problem solve with other departments in order to assist member problem resolution. Prioritizes, delegates, and supervises work assignments appropriately to ensure completion of patient care activities. Complies with regulatory requirements, policies, procedures, and standards of practice. Nursing Process: Develops and/or contributes to the individualized plan of care that reflects assessment, planning, implementing, and evaluating the outcomes of that plan. Ensures plan shows multidisciplinary planning, consultation, and education. Ensures plan is reflective of admission or outpatient database, on-going findings, age appropriate care, cultural specific needs, and appropriate acuity. Ensures plan is discussed with patient, family/significant others, and completed in a timely manner. Monitors the patient's progress based on the plan. Revises plan on ongoing basis based on patient condition and evaluation of progress. Ensures care meets standards of practice. Ensures effective development and completion of discharge plan including discharge barriers and patient/family education. Ensures that patient clearly understands discharge instructions. In outpatient, identify barriers and needs for patient/family education that will facilitate the outpatient medical management plan. Ensures patient safety related but not limited to, medications and procedures utilizing the five rights; patient falls; decubitus prevention and prevention of nosocomial infections. Ensures optimal pain control and patient comfort; identifies and discusses patient anxieties, fears or concerns regarding patient condition, treatment or discharge. Ensures that patient understands medication purpose, side effects, and administration instructions in the hospital as well as at the time of discharge. Documentation: Charting is accurate, legble, dated, and timed. Documentation reflects nursing process and interventions and evaluations taken. Utilizes computer systems effectively and efficiently for optimal patient care. Clinical Outcomes: Discusses patient findings and progress toward outcomes with physicians and other members of the health care team. Demonstrates competencies during the probationary period and ongoing completion by departmental competency validation. Make comprehensive nursing decisions based on interpretation of data, assessments, and evaluations of patient outcomes. Participates in departmental performance improvement activities, i.e., planning, measuring/monitoring, assessing, and improving. Workplace Safety: Adherence to Workplace Safety principles and practices. Applies standard precautions; maintains a safe environment for self and others. Patient Care Experience: Practices customer service standards as defined by the Service Area, Medical Center, and specified department. Promptly answers call lights, alarms, and patient requests. Makes appropriate referrals and facilitates the customer's ability to utilize resources. Maintains and protects patient confidentiality. Ensures clean, orderly, and functional work environment. Treats all families of patients with courtesy, respect, kindness and compassion. Provides an optimal patient care experience by actively listening to the needs of patients and family members and taking responsibility for meeting those identified needs. Gives patients information in a way they can understand and ensures comprehension. Provides a patient care experience that exceeds members' expectations. Team Commitment: Viewed by others to be an effective team member who is flexible, cooperative, and willing to assist others. Confronts difficult or conflict situations constructively and seeks appropriate assistance. Takes accountability for own actions and accepts constructive criticism. Acts as a resource, preceptor, and mentor to new employees, registry, students, and other team members. Attends all mandatory meetings, in-services and staff meetings as required, actively participates in other departmental professional development. (Requirement may vary for per diem staff). Participates with the assessment of current and future unit learning needs and development of an annual education plan. Keeps self informed of activities on the unit and makes recommendations for change. Adheres to Attendance Program. Reports to assigned area promptly, being present and available for report at beginning of assigned shift. Supports a collaborative Labor-Management Partnership environment through unit based teams. Fiscal Responsibility: Organizes work to minimize the use of overtime. Identifies and assists in systems improvement that needs simplification or correction. Utilizes payroll and non-payroll resources to their maximum potential. The above statements are intended to describe the general nature and the level of work being performed by the individuals assigned to this position and as such are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified. MORENO VALLEY NURSING IN & OUT PATIENT SETTING REQUIREMENTS NURSERY-Current CA RN license. BLS and NRP certifications. One (1) year recent (within the last three (3) years) full-time equivalent experience in a nursery setting. OBSTETRICS (OB)-Current CA RN license. BLS and NRP certifications. One (1) year recent (within the last 3 years) full-time equivalent experience in Maternal/Child Health, OB/GYN or Women's Health in an acute care setting. TELEMETRY / MED SURG- TELE- Current CA RN license. ACLS and BLS certifications. Successful completion of a Basic Arrhythmia course. One (1) year recent (within the last three (3) years) full-time equivalent experience in an acute care setting. RECOMMENDED VERBIAGE TO BE ADDED TO ANY AND ALL POSITIONS WILLING TO CONSIDER NEW GRADS. RN/IP's - new graduates and experienced RN's not meeting the above requirements: Applicant must be a graduate of a BRN approved RN program and have completed 917 hours of supervised RN student clinical training or as an RN applicant, is an LVN who has graduated from an accredited, licensed vocational nursing program that included supervised clinical student experience and has a minimum of one (1) year of experience as an LVN in the clinical area of RN hire within the past three years or comparable clinical area as defined by the medical facility. Applicants will be required to successfully complete a Kaiser Permanente Nursing Orientation Program. IP applicants must receive RN license within 3 months of hire. This language does not prescribe that you must hire an inexperienced RN. Certifications for RNs working at Moreno Valley Community Hospital prior to ownership by Kaiser Permanente: Employees acquired through the purchase of Moreno Valley Community Hospital from Valley Health System will continue to have up to 6 months from their original date of hire with Valley Health System to obtain the required certifications/courses for the specific unit on which they work, including: Successful completion of a Basic Arrhythmia course Advanced Cardiac Life Support (ACLS) certification Neonatal Resuscitation Program (NRP) certification Pediatric Advanced Life Support (PALS) certification Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures. In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors. Kaiser Permanente is an EEO/AA Employer. Basic Qualifications: Current CA RN license.ACLS and BLS certification.Successful completion of a Basic Arrhythmia course.One (1) year recent (within the last three (3) years) fulltime equivalent experience in an acute care setting.PALS certification within 3 months of hire. Preferred Qualifications: BSN preferred. Primary Location: California,Moreno Valley,Moreno Valley Community Hospital 27300 Iris Ave. Scheduled Weekly Hours: 0 Shift: Night Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: 7:00 PM Working Hours End: 7:30 AM Job Schedule: Per Diem Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: SEIU - Local 121 Job Level: Individual Contributor Job Category: Nursing Licensed Department: Medical Surgical Travel: No Click here for additional requirements > Kaiser Permanente Moreno Valley CA

Case Manager Utilization RN

Expired Job

Kaiser Permanente