Case Manager Utilization RN, 20/hr Day

2 weeks ago

Ontario, United States Kaiser Permanente Full time
Sign On Bonus for Eligible External Hires
Job Summary:

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 Responsibilities:

    • 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.

    • Participates in the Bed Huddles and carries out recommendations congruent with the patients needs.

    • 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; maintains and provides required documentation.

    • 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.


Basic Qualifications:
Experience

    • Two (2) years combined RN experience in an acute care setting or case management required.


Education

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


License, Certification, Registration

    • Registered Nurse License (California)


    • Basic Life Support


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:

    • Bachelors degree in nursing or healthcare related field.


 



Notes:



    • Weekend requirements: Evey other weekend

  • Case Manager Utilization RN, 20/hr Day

    3 weeks ago

    Ontario, United States Kaiser Permanente Full time

    Sign On Bonus for Eligible External Hires Job Summary: 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,...

  • Case Manager Utilization RN, PD Day

    1 month ago

    Ontario, United States Kaiser Permanente Full time

    Job Summary: 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...

  • Case Management Utilization RN, ED PD Night

    4 days ago

    Ontario, United States Kaiser Permanente Full time

    Job Summary: 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...

  • Case Management Utilization RN, ED PD Night

    2 weeks ago

    Ontario, United States Kaiser Permanente Full time

    Job Summary: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...

  • Registered Nurse

    2 days ago

    Ontario, United States AMN Healthcare Full time

    Job Details 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...

  • Healthcare Utilization Manager

    1 week ago

    Ontario, California, United States Kaiser Permanente Full time

    About the RoleWe are seeking a skilled Healthcare Utilization Manager to join our team at Kaiser Permanente in Ontario, California.This nursing position involves working collaboratively with physicians to coordinate and screen admissions and continued stays. The ideal candidate will have experience in an acute care setting or case management and possess...

  • Senior HR Advisor

    3 months ago

    Ontario, United States J.R. Simplot Full time

    The J.R. Simplot Company is a diverse, privately held global food and agriculture company headquartered in Boise, Idaho. We are a true farm-to-table company with an integrated portfolio including food processing and food brands, phosphate mining, fertilizer manufacturing, farming, ranching and cattle production, and other enterprises related to...

  • Compensation Business Partner

    4 days ago

    Ontario, United States HR Search Co. Full time

    Our client is a nationwide manufacturing company, with 2,500 employees across the US. This is a corporate role at the HQ in Ontario, CA. Hybrid, individual contributor, reports to the Director of Total Rewards. The Compensation Business Partner will play a crucial role in collaborating with business leaders and HR Business Partners, providing expertise and...

  • Compensation Business Partner

    4 days ago

    Ontario, United States HR Search Co. Full time

    Our client is a nationwide manufacturing company, with 2,500 employees across the US. This is a corporate role at the HQ in Ontario, CA. Hybrid, individual contributor, reports to the Director of Total Rewards. The Compensation Business Partner will play a crucial role in collaborating with business leaders and HR Business Partners, providing expertise and...

  • RN Case Mgr

    3 weeks ago

    Ontario Center, United States Rochester Regional Health Full time

    HOW WE CARE FOR YOUAt Rochester Regional Health, we are dedicated to getting health care right. Our robust benefits and total rewards foster employee wellbeing, professional development and personal growth. We care for your career while caring for the community.Sign On BonusMileage AllowanceFlexible SchedulingHealth & Wellness Benefits starting Your First...

  • $20/hour | lululemon Warehouse Associate

    4 weeks ago

    Ontario, United States Array Corporation Full time

    Job DescriptionJob DescriptionPosition: lululemon Warehouse AssociateLocation: Ontario, CAPay: $20/hourExperience: Previous related experience is preferred but not requiredType: Full-time; ContractSchedule: Swing Shift, Monday - Friday, 3:00pm to 11:30pmLogic Staffing is seeking a lululemon Warehouse Associate to join a growing and dynamic team!Job...

  • Sr Electrician

    4 weeks ago

    Ontario, United States Fuze HR Full time

    Senior Industrial Electrician 309A or 442A Robotics & AutomationAre you a proactive self-starter eager to take on new challenges, from wiring conveyor lines to constructing control panels? Step into a rewarding career where your skills and ambitions are valued, alongside a team committed to fostering growth and providing support a supportive environment for...

  • Staff RN

    3 weeks ago

    Ontario, United States Kaiser Permanente Full time

    Job Summary: 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...

  • Service Center Coordinator

    3 months ago

    Ontario, United States Ajinomoto Foods North America Full time

    Overview The HR Service Center Coordinator is responsible for providing administrative support and assistance to the HR Service Center team. They will handle employee inquiries and requests related to HR policies, procedures, and programs - ensuring that all HR inquiries and requests are handled in a timely and efficient manner. They provide direct support...

  • RN Emergency Department Coordinator Full-Time Days

    4 weeks ago

    Ontario, United States Saint Alphonsus Health System Full time

    Employment Type:Full timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.We are looking to hire...

  • RN Emergency Department Coordinator Full-Time Days

    4 weeks ago

    Ontario, United States Saint Alphonsus Health System Full time

    Employment Type:Full timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.We are looking to hire...

  • RN Emergency Department Coordinator Full-Time Days

    4 weeks ago

    Ontario, United States Saint Alphonsus Health System Full time

    Job DescriptionEmployment Type:Full timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.We are...

  • RN Emergency Department Coordinator Full-Time Days

    4 weeks ago

    Ontario, United States Saint Alphonsus Health System Full time

    Employment Type:Full timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.We are looking to hire...

  • RN Emergency Department Coordinator Full-Time Days

    4 weeks ago

    Ontario, United States Saint Alphonsus Health System Full time

    Employment Type:Full timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.We are looking to hire...

  • Human Resources Manager

    4 weeks ago

    Ontario, United States Rockwell Care Full time

    Rockwell Healthcare is HIRING! Our mission is to take great care of those who work with us, and those with whose care we have been entrusted. We are looking for people who love their jobs. People who are committed to working as a team, have high expectations for themselves and for the facility they work in. We are looking for an Experienced HR, who have...