Nephrology Care Coordinator

3 days ago

Sacramento, California, United States Kaiser Permanente Full time
Job Summary

As a Kidney Care Coordinator, Registered Nurse, you will play a critical role in providing care coordination, case management, and clinical management for patients with chronic kidney disease (CKD), including end-stage kidney disease (ESKD) and renal replacement therapy (RRT). You will collaborate with internal and external providers to coordinate the plan of care and provide expertise in CKD/ESKD/RRT management and treatments, including dialysis.

Key Responsibilities
  • Act as a care coordinator for the care and follow-up of patients in the nephrology specialty clinic and dialysis centers, including contracted transplant centers.
  • Provide holistic, proactive coordination of care for chronic disease under Nephrologist supervision.
  • Using standardized policies, procedures, and standing orders, coordinate clinical care and education for symptoms, complications, labs, and medications by protocol.
  • Navigate complex care, including arranging and monitoring follow-up appointments, encouraging members to follow prescribed courses of care, and making referrals to appropriate community/contracted services.
  • Collaborate with patients, patient support, and interdisciplinary team members in assessing patient needs, including scheduled follow-up for self-care skill building, diet and other risk factor counseling, and medication management in the medical office setting.
  • Assess patient readiness to learn and make lifestyle changes using motivational interviewing techniques, teach and reinforce self-care skills.
  • Provide patient education and consultation for patients and family members throughout disease progression.
  • Coordinate care using the interdisciplinary care approach to provide continuity of care for CKD/ESKD patients, including coordination with other programs such as chronic condition management, specialty care, surgical care, supportive care services, and others to ensure seamless transitions.
  • Participate in performance improvement activities to enhance and monitor the quality and level of care provided for patients with CKD/ESKD disease under nephrology care.
  • Identify and promote improved innovative clinical practice based on new knowledge and research in the field of specialization, using a broad scope of nursing expertise.
  • Maintain up-to-date knowledge of current activities in Nephrology, CKD/ESKD/RRT care.
  • Ensure accurate clinical information and data is maintained.
  • Perform other nephrology-specific duties to support CKD and ESKD patient population needs.
Requirements
  • Minimum of two (2) years of dialysis and/or nephrology case management experience within the past five (5) years.
  • Bachelor's degree in nursing or health-related field, or four (4) years of experience in a directly related field.
  • Graduate of an accredited school of nursing.
  • High School Diploma or General Education Development (GED) required.
  • Registered Nurse License (California) required at hire.
  • 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: Previous care coordination experience in Nephrology, Masters degree, Certified Nephrology Nurse (CNN) or Certified Dialysis Nurse (CDN) preferred upon hire date, but required to obtain within 2 years of hire.

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