RN Utilization Manager
2 days ago
As a RN Utilization Manager at Kaiser Permanente, you will play a critical role in coordinating and screening patient admissions and continued stays. You will work collaboratively with physicians to make recommendations for alternate levels of care when patients do not meet medical necessity for inpatient hospitalization. Your interactions with patients, families, and other disciplines will ensure a safe and acceptable discharge plan. You will function as an indirect caregiver, patient advocate, and manage patients in the most cost-effective way without compromising quality. You will transfer stable non-members to planned healthcare facilities and comply with AB 1203, Post Stabilization notification. You will also comply with other duties as described. You must be able to work collaboratively with the multidisciplinary team, multitask, and work in a fast-paced environment.
Essential Responsibilities:
- Plans, develops, assesses, and evaluates care provided to members.
- Collaborates with physicians, other members of the multidisciplinary healthcare team, and patient/family in the development, implementation, and documentation of appropriate, individualized plans of care to ensure continuity, quality, and appropriate resource use.
- Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
- Assesses high-risk patients in need of post-hospital care planning.
- Develops and coordinates the implementation of a discharge plan to meet patients' identified needs.
- Communicates the plan to physicians, patient, family/caregivers, staff, and appropriate community agencies.
- Reviews, monitors, evaluates, and coordinates patients' hospital stays to assure that all appropriate and essential services are delivered timely and efficiently.
- Participates in Bed Huddles and carries out recommendations congruent with patients' needs.
- Coordinates 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.
- Conducts 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.
- Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
- Refers patients to community resources to meet post-hospital needs.
- Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation.
- Adheres to internal and external regulatory and accreditation requirements and compliance guidelines, including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA, and DOL.
- Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
- Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
- Per established protocols, reports any incidence of unusual occurrences related to quality, risk, and/or patient safety which are identified during case review or other activities.
- Reviews, analyzes, and identifies utilization patterns and trends, problems, or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
- Coordinates, participates, and/or facilitates care planning rounds and patient family conferences as needed.
- Participates in committees, teams, or other work projects/duties as assigned.
- 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)
- Basic Life Support
- Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques, and methods of Utilization review/management, discharge planning, or case management.
- Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
- Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking, and problem-solving skills.
- Demonstrated ability in planning, organizing, conflict resolution, and negotiating skills.
- Computer literacy skills required.
- Bachelors degree in nursing or healthcare-related field.
- Every other weekend
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 08:00 AM
Working Hours End: 04:30 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: B21|AFSCME|SCNSC
Job Level: Individual Contributor
Department: West LA Medical Center - Utilization Management
Pay Range: $59.6 - $72.94 / hour
Sign on bonus: $ 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 Kaiser Permanente
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