Case Manager

3 weeks ago

KailuaKona, United States tapwage Full time

Description:

Job Summary:

Provides case management and outreach services to selected patients. Provides discharge planning services and assists with follow-up for Health Plan members hospitalized at community hospitals. Incorporates Risk Management, Quality Management and Utilization Management concepts into daily hospital and clinic activities.

Essential Responsibilities:

- Implements Continuing Care programs and initiatives with Continuing Care providers and PCP Team. Assists with integrating programs and initiatives into daily practice. Makes clinic/location-specific adaptations as necessary to insure successful implementation of model. Monitors and evaluates outcomes.
- Provides case management services to targeted patients/families by interviewing and evaluating their needs. Develops work plans to assist patients/families in meeting identified needs. Coordinates resources and services to assure continuity and quality of care. Maintains working knowledge of community resources. Interprets Kaiser Permanente benefits/services to patients, families, and members of community.
- Monitors high-risk members and assists them with access to care. Integrates patients into existing programs/services. Evaluates outcomes and makes recommendations for change.
- Assists patients/families with identified problems/concerns.
- Meets with Continuing Care providers and PCP Team to monitor targeted patients. Assists Team by coordinating community care. Explores options to assure that quality, cost-efficient care is provided.
- Makes daily hospital rounds for early identification of UM and discharge planning activities. Assists physician/patient/family in planning discharge. to facilitate smooth transfer to home or alternate facility.
- Reports any Risk/Quality/Utilization Management issues to Neighbor Island Management Team.
- Acts as contact person for MOA/Oahu discharges. Assists patients with smooth transfer to home.
- Participates in community hospital interdisciplinary team meetings.
- Maintains confidentiality of all patient information.
- May perform patient care to the extent necessary to maintain clinical expertise, competency and licensing necessary to fulfill job responsibilities and to direct the provision of care on the unit.
- Develops and maintains collegial and consultative working relationship with Government Programs office staff to assure that all regulatory requirements are met and necessary changes are implemented.
- Attends community seminars and workshops specific to professional needs. Participates in approved educational programs.
- Assists in developing, implementing, maintaining, evaluating, and enhancing Total Quality Management activities within organization. Makes suggestions for change/improvement as indicated.
- Incorporates the KP Nursing Vision, Model and Values through out their Nursing Practice.

Basic Qualifications:

Experience

- Minimum one (1) year of working with low income/high risk patients, preferably in healthcare setting, including experience or successful completion of training program (pre-hire, post-hire, or on-the-job) in area of specialty, if applicable.

Education

- Bachelors degree in nursing OR four (4) years of experience in a directly related field.

License, Certification, Registration

- Registered Nurse License (Hawaii) required at hire
- Basic Life Support from American Heart Association

Additional Requirements:

- Case management/community outreach experience.
- Demonstrated knowledge of and skill in oral communication, written communication, interpersonal relations, customer service, change management, multi-task and problem solving.
- Demonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.

Preferred Qualifications:

- Program development and operations level implementation.
- Geriatric experience in outpatient clinic setting.
- Supervisory/lead experience.

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