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Case Manager RN

2 months ago

Fresno, United States Kaiser Permanente Full time
Job Summary:
Please be aware that this position is currently under review as part of the jurisdictional process with the California Nurses Association to determine whether such position should be assigned to the CNA bargaining unit. This review is on a position-by-position basis and includes an analysis of the actual duties performed in each position under review. This determination will be made within the next several months. Should the determination be made that the position does belong to the CNA bargaining unit, you will be offered the opportunity to (a) follow the work into the CNA bargaining unit and become a member of the union, or (b) seek other employment within the organization. Should you have any questions regarding this notice, please contact your recruiter for further information. Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care. In conjunction with physicians, develops treatment plan, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care.
Essential Responsibilities:

  • Plans, develops, assesses, and evaluates care provided to members. Develops and maintains case management policies and procedures. Coordinates, directs, and performs concurrent and retrospective reviews, and monitors level and quality of care.
  • 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.
  • Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization.
  • Coordinates repatriation of patients and monitors their quality of care.
  • Arranges and monitors follow-up appointments. Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy). Makes referrals to appropriate community services.
  • Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
  • Develops and collects data, and trends utilization of health care resources.
  • Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
  • Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
  • Acts as liaison for outside agencies, non-plan facilities, and outside providers. In conjunction with physicians, evaluates and develops treatment plans, recommends alternative levels of care, and ensures compliance with federal, state, and local requirements.
  • 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.

Basic Qualifications:
Experience

  • N/A

Education

  • Graduate of an accredited school of nursing.
  • Bachelors degree in nursing or health related field, OR four (4) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.

License, Certification, Registration

  • Registered Nurse License (California)

Additional Requirements:

  • Knowledge of Nurse Practice Act, The Joint Commission and other federal/state/local regulations.
  • Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

  • Minimum six (6) months of previous case management experience preferred.
  • Experience in utilization management, discharge planning, or transfer coordination.
  • PHN preferred.
  • Masters degree preferred.