Case Manager Utilization RN
7 days ago
Kaiser Permanente seeks a skilled Case Manager Utilization RN to join our team. As a key member of our multidisciplinary team, you will work collaboratively with physicians to coordinate and screen for the appropriateness of admissions and continued stays. Your expertise will be essential in making recommendations to physicians for alternate levels of care when patients do not meet the medical necessity for inpatient hospitalization.
Key Responsibilities:- Develop and implement individualized plans of care to ensure continuity, quality, and appropriate resource use.
- Collaborate with physicians, other healthcare professionals, and patients/families to coordinate discharge planning and ensure a smooth transition to post-hospital care.
- Conduct daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in various settings.
- Act as a liaison between in-patient facilities and referral agencies, providing case management to patients referred.
- Refers patients to community resources to meet post-hospital needs and coordinates transfer of patients to appropriate facilities.
- Adheres to internal and external regulatory and accreditation requirements, including TJC, DHS, HCFA, CMS, DMHC, NCQA, and DOL.
- 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) and Basic Life Support certification required.
- Bachelor's degree in nursing or healthcare-related field.
Notes:
- Weekend requirement: every other weekend.
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