Nurse Care Specialist

2 days ago

Simi Valley, California, United States Kaiser Permanente Full time
About Kaiser Permanente

Kaiser Permanente is a not-for-profit integrated health plan that makes a difference in the lives of members, patients, and communities across the country.

Job Title: Registered Nurse (RN) Case ManagementLocation: Ventura, California

Estimated Salary: $90,000 - $120,000 per yearAbout the Job

We are seeking a highly skilled Registered Nurse (RN) to join our team as a Case Manager. As a Case Manager, you will work with physicians, other healthcare professionals, and patients/families to develop and implement individualized plans of care. Your primary goal will be to ensure continuity, quality, and efficient use of resources.

  • Makes recommendations to physicians for alternate levels of care when the patient does not meet medical necessity for Inpatient hospitalization.
  • Functions as an indirect caregiver, patient advocate, and manages patients in the most cost-effective way without compromising quality.
  • Transfers stable non-members to planned Health care facilities.
  • Plans, develops, assesses, and evaluates care provided to members.
Key Responsibilities
  1. 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.
  2. Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
  3. Assesses high-risk patients in need of post-hospital care planning.
  4. 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.
  5. Reviews, monitors, evaluates, and coordinates patients' hospital stays to assure that all appropriate and essential services are delivered timely and efficiently.
Requirements

To be successful in this role, you must have:

  • Two 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.
Preferred Qualifications
  • 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 in planning, organizing, conflict resolution, and negotiating skills.
  • Computer literacy skills required.
About Us

At Kaiser Permanente, we make a difference in the lives of our members, patients, and communities by pioneering health outcomes, encouraging diverse viewpoints, and creating new opportunities for learning and advancement.

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