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Case Manager RN
1 month ago
As a Case Management Utilization RN with Kaiser Permanente, you will work collaboratively with physicians to coordinate and screen for the appropriateness of admissions and continued stays. You will make recommendations to physicians for alternate levels of care when patients do not meet the medical necessity for inpatient hospitalization.
Key Responsibilities:- Plan, develop, assess, and evaluate care provided to members.
- Collaborate with physicians, other members of the multidisciplinary healthcare team, and patients/families in the development, implementation, and documentation of appropriate, individualized plans of care to ensure continuity, quality, and appropriate resource use.
- Recommend alternative levels of care and ensure compliance with federal, state, and local requirements.
- Assess high-risk patients in need of post-hospital care planning.
- Develop and coordinate the implementation of a discharge plan to meet patients' identified needs; communicate the plan to physicians, patients, family/caregivers, staff, and appropriate community agencies.
- Review, monitor, evaluate, and coordinate patients' hospital stays to ensure that all appropriate and essential services are delivered timely and efficiently.
- Participate in bed huddles and carry out recommendations congruent with patients' needs.
- Coordinate 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.
- Conduct 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.
- Act as a liaison between in-patient facilities and referral facilities/agencies and provide case management to patients referred.
- Refer patients to community resources to meet post-hospital needs.
- Coordinate transfer of patients to appropriate facilities; maintain and provide required documentation.
- Two (2) years combined RN experience in an acute care setting or case management required.
- Completion of an accredited RN training program that allows graduates to take RN license exam.
- Registered Nurse License (California).
- Bachelor's degree in nursing or healthcare-related field.
- ACUTE CASE MANAGEMENT, hospital experience preferred.
This assignment is a UM department CM in-.
