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Patient Care Coordinator Case Manager

2 months ago

Santa Clara, United States Kaiser Permanente Full time
Description: Job Summary:

Coordinates with physicians, staff and non-Kaiser providers and facilities regarding patients transitions and discharge planning. In conjunction with physicians, develops plans of care and discharge plans, and makes recommendations for alternative levels of care as required.
Essential Responsibilities:

  • Utilization Management: Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.
  • Monitors the progression of the discharge plan and facilitates discussions with the multidisciplinary teams.
  • Educates other healthcare team members on utilization and care coordination.
  • Collaborates with and provides information to patients, families, physicians, and staff regarding the discharge plans and transitions.
  • Understands and consistently applies the interpretation, and utilization of member health care benefits.
  • Conducts UM, care coordination and discharge planning activities according to all applicable regulatory requirements.
  • Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.
  • Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other health care providers and agencies.
  • Regulatory: Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory 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

  • Minimum four (4) years of experience in hospital patient care delivery, OR completion of Masters degree in case management program in lieu of minimum years of experience.
Education

  • Graduate of accredited school of nursing.
  • Diploma/Associate Degree Nursing.
License, Certification, Registration
  • Registered Nurse License (California)
  • Basic Life Support
Additional Requirements:

  • Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations.
  • Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
  • Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations.
  • Knowledge of health care benefits associated with various business line (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).
  • Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:

  • Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
  • Bachelors degree in nursing or a health care related field preferred.
  • Masters degree in case management preferred.


Primary Location: California,Santa Clara,Santa Clara Hospital
Scheduled Weekly Hours: 24
Shift: Day
Workdays: Week 1: Sun, Mon, Tue; Week 2: Mon, Tue, Sat
Working Hours Start: 08:00 AM
Working Hours End: 04:30 PM
Job Schedule: Part-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: A10|NNU|California Nurse's Association
Job Level: Individual Contributor
Department: Santa Clara Homestead Hospital - UR-Discharge Planning - 0201
Pay Range: $81.02 - $96.24 / hour The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No
On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest