Kaiser Permanente Transitions Program Case Manager in Martinez, California
Provides inpatient and intensive outpatient case management for high-risk, high-utilizing members with acute and/or chronic psychiatric conditions across the continuum of care. Develops treatment and care plans for the specific population.Essential Functions:- Plans, develops, coordinates, assesses, and evaluates services provided to members to promote quality and cost effective outcomes.- Develops and maintains case management policies and procedures to assure optimal and appropriate member utilization of services.- Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals for outside services.- Participates in the development of care paths.- As an Intensive Case Manager coordinates the care of a large caseload of high risk patients and provides assessments and interventions in the community including in-home visits Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization.- Arranges and monitors follow-up appointments.- Makes referrals to appropriate community services.- Identifies and recommends opportunities for cost savings and quality of care improvements across the continuum.- Develops and collects reports and data, and trends utilization of health care resources.- Develops and presents in-service training and communication to both internal and external stakeholders.- Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.- Coordinates the transmission of clinical and benefit information and treatment to patients, families and outside agencies including issuing Non-Coverage and Denial of Benefits letters consistent with Health Plan Regulations.- Acts as liaison to psychiatry clinics outside agencies, non-plan facilities, and outside providers. - Coordinates repatriation of patients and monitors their quality of care. Provides administrative case management oversight to Inpatient Psychiatric Facilities, Crisis Residential Programs, and IMDs to ensure that services delivered to our members meet Kaiser's Quality and Utilization expectations and guidelines.- Provides administrative on-call to the RSR/Sub regional Office. Provides Clinical and Administrative documentation in accordance with Kaiser Regional Psychiatric Standards including the Inpatient/Integrated Urgent Services Guidelines.- Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente 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.
The Transitions Program Case Manager provides short-term outpatient case management that addresses both medical and non-medical barriers, which have a direct impact on a member's ability to effectively self-manage their complex/chronic condition and/or appropriate utilization of KP and community resources.
Basic Qualifications:- Previous experience, usually two (2) years in an inpatient psychiatric setting or psychiatric emergency service.- Previous experience, usually two (2) years of care management or clinical experience, and responsibility for a large caseload (50-100) for an extended period of time.- Demonstrated experience in utilization data collection and cost benefit analysis.- Master's (Social Work or Psychology), or PhD (Psychology) required. - LCSW, MFT or Psychologist License required.- Must have a National Provider Identifier (NPI), or obtain an NPI, prior to employment start date.- Demonstrated expertise in crisis management.- Knowledge of TJC, and other local, state, and federal regulations.- Must be able to work in a Labor Partnership Environment.
TITLE: Transitions Program Case Manager
LOCATION: Martinez, California
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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.