Medical Care Nurse
2 weeks ago
Kaiser Permanente is seeking a Registered Nurse (RN) Case Management for a nursing job in Irvine, California.
Specialty: Case Management
~ Shift: 8 hours, nights
~ Employment Type: Staff
Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. 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. Plans, develops, assesses and evaluates care provided to members.
Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use.
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 the implementation of a discharge plan to meet patients identified needs; communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies.
Reviews, monitors, evaluates and coordinates the patients hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and 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 and non-KFH facilities.
Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
Refers patients to community resources to meet post hospital needs.
Coordinates transfer of patients to appropriate facilities; Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOL.
Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and 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 and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed.
Participates in committees, teams or other work projects/duties as assigned.
Two (2) years combined RN experience in an acute care setting or case management required.
Completion of an accredited RN training program that allows graduates to take RN license exam.
License, Certification, Registration
· 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.).
· Case Manager Utilization Rn - Pd Night
At the heart of health care, you'll find Kaiser Permanente. As the nations leading not-for-profit, integrated health plan, we make a difference in the lives of members, patients, and communities across the country.
Whether you choose to join a hospital in the Northwest, a clinic in Southern California, or a medical office in the Mid-Atlantic, we have many opportunities for you to shape the future of care.
Our teams are empowered to advance impactful and extraordinary care for all by pioneering health outcomes, encouraging diverse viewpoints, and creating new opportunities for learning and advancement. it also reaches far into our communities.
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