Case Manager

3 weeks ago

Wailuku HI United States Kaiser Permanente Full time
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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