RN, Inpatient Case Manager, Full Time
2 weeks ago
As a RN, Inpatient Case Manager at Kaiser Permanente, you will play a critical role in optimizing quality and efficiency of care for hospitalized members. You will work collaboratively with physician partners to develop and implement daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care. Your goal will be to develop a safe discharge plan, recommending alternative levels and sites of care when appropriate. This will involve daily review of hospital care by chart review and discussion with attending physician, admission and concurrent review for inpatient admissions, meetings with patient and families to develop discharge planning, identification of patients for ambulatory case management, communication with case managers, home care reviewers, social workers, members and providers, quality improvement reviews, and education of the member/family, provider and hospital staff. You will achieve desired utilization and quality outcomes and promote high customer satisfaction to the population served.
Key Responsibilities
- Develop and implement individualized plans of care to ensure continuity, quality, and appropriate resource use. Collaborate with physicians, other members of the multidisciplinary healthcare team, and patient/family to develop, implement, and document plans of care.
- Review and monitor patients' hospital stays to ensure timely and efficient delivery of all appropriate and essential services. Communicate with hospitalist partners via huddles multiple times throughout the day.
- Assess high-risk patients in need of post-hospital care planning and develop and coordinate the implementation of a discharge plan to meet each patient's identified needs. Communicate the plan to physicians, patient, family/caregivers, staff, and appropriate community agencies to enhance the effect of a seamless transition from one level of care to another across the continuum.
- Perform psychosocial assessments on all patients that meet high-risk indicators for discharge planning. Comprehensively assess patients' goals, biophysical, psychosocial, environmental, economic/financial, and discharge planning needs. Provide patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
- Refer patients to ambulatory case managers, care managers, and/or social workers as appropriate. Document all admissions and discharges in the patients' Kaiser Permanente electronic medical record. Make post-discharge follow-up calls to all patients who are not referred to an ambulatory case/care management program.
- Attend scheduled rounds with the Physician Director of Resource Stewardship to discuss clinical course and discharge planning for assigned patients, identifying any real or potential delays in care or quality of care issues.
- Act as a liaison between inpatient facility and referral facilities/agencies, providing case management to patients referred, serving as an advocate for patients and families. Coordinate transfer of patients to appropriate facilities; maintain and provide required documentation. Build highly effective working relationships with physicians, SNF staff, vendors, and other departments within the health plan.
Requirements
- Minimum two (2) years of experience in patient care delivery or completion of Masters degree in Case Management Program in lieu of minimum years of experience.
- Associates Degree in Nursing.
- Registered Professional Nurse License (Georgia).
- Demonstrated advanced communication and interpersonal skills with all levels of internal & external customers, including but not limited to medical staff, patients and families, clinical personnel, support and technical staff, outside agencies, and members of the community.
- Ability to collaborate effectively with multidisciplinary healthcare team.
- Excellent time management skills with the ability to work successfully in a fast-paced environment. Must be self-directed, and have the ability to tolerate frequent interruptions and a demanding work load.
- Functional knowledge of computers.
- Experience with managed health care delivery including Medicare.
- Experience in a payer environment highly desirable.
- Knowledge of funding, resources, services, clinical standards, and outcomes is preferred.
- Complex Case Management Certification preferred.
- 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 healthcare benefits associated with various business lines.
Preferred Qualifications
- Minimum five (5) years of clinical nursing experience in a hospital setting.
- Minimum five (5) years of professional practice experience in an acute care setting.
- Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
- Bachelors Degree in Nursing, Health Care or Masters degree in Case Management.
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