Kaiser Permanente Case Manager Outside Utilization RN in Los Angeles, California

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.

Qualifications: Basic Qualifications: Experience - Minimum two (2) years clinical experience as an RN in Critical Care or case management required. - For positions in KP Reconnect & Transitional Care Case Management Program only (substitute first sentence above): 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. - Must have excellent prioritization skills, juggle multiple pt care issues requiring follow-up while addressing pt transition events (ED, IP, planned surgeries, SNF to home). - E xcellent customer service. - W ritten/verbal communication skills; collaboration. - Recent experience in acute clinical, SNP and telephonic case mgmt. preferred.

Notes: - Will manage a dynamic and sizable caseload across the continuum telephonically. - W ill assist Dept. SW's in pending any labs/orders related to pt care, participate in daily huddles, weekly ICT meetings, etc.-Provides seamless backfill to the team, and provide support as needed, such as when daily caseload is managed. - Will also manage the tele-health initiatives for pts on caseload, be trained and facilitate LCP conversations, and be cross-trained in all dept. - Must be able to effectively collaborate/consult within an IDT and with IP CM, LTC and HH colleagues alike.

COMPANY Kaiser Permanente

TITLE Case Manager Outside Utilization RN

LOCATION Los Angeles, CA