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Nurse Case Manager
2 months ago
Kaiser Permanente is seeking a skilled Registered Nurse (RN) to fill a Case Management position in our Bakersfield, California location.
Key Responsibilities- Collaborate with assigned physicians to manage patients' specialized needs and develop individualized care plans.
- Assess patients' needs and develop specific care management plans to address those needs.
- Implement care/treatment plans by coordinating access to health services across multiple providers/disciplines, monitoring care, and making determinations to arrange transportation and transfers as needed.
- Identify cost-effective measures, make recommendations for alternative levels of care, and utilize resources effectively.
- Promote self-care management and ensure accurate documentation of patient care.
- Interface with Primary Care Physicians, Specialists, and various disciplines to develop case management plans/programs.
- Monitor and evaluate the effectiveness of case management plans and modify as necessary.
- Coordinate the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations/approvals/transfers as needed.
- Act as a clinical liaison with outside agencies, such as County CCS, non-plan facilities, outside providers, employers, and/or workers' compensation carriers and third-party administrators.
- Prepare reports, communicate program changes to appropriate staff, and develop protocols in accordance with state regulations.
- Act as a patient advocate and educator to ensure patients have the knowledge to care for their condition and are empowered to participate in their plan of care.
- Develop individualized patient/family education plans focused on self-management and deliver patient/family education specific to a disease state.
- Develop and update training and educational materials and present to appropriate staff, members, and families.
- Facilitate patients' return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
- Consult with internal and external physicians, healthcare providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
- May need to facilitate transportation and housing arrangements for patients.
- Participate in data collection and analysis of clinical outcomes of care and customer satisfaction standards.
- Participate in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service.
- Ensure accurate records are maintained of the care associated with each patient.
- Interpret regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.
- Minimum two (2) years clinical experience as an RN in an acute care or ambulatory care setting required.
- Bachelor's degree or equivalent experience four (4) years required.
- Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques, and methods of utilization review/management, care coordination, transfer coordination, discharge planning, or case management.
- Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
- Computer literacy skills required.
- Bachelor's degree in nursing or healthcare-related field preferred.
- ~2 years GI experience required.
