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Inpatient Psychiatric Case Manager
2 months ago
As an Inpatient Psychiatric Case Manager at Kaiser, you will play a critical role in providing high-quality care to our members with acute and chronic psychiatric conditions. Your expertise will be essential in developing and implementing treatment plans that promote optimal outcomes and cost-effective care.
Key Responsibilities:- Case Management: Plan, develop, coordinate, assess, and evaluate services provided to members to ensure quality and cost-effective outcomes.
- Policies and Procedures: Develop and maintain case management policies and procedures to ensure optimal and appropriate member utilization of services.
- Interdisciplinary Collaboration: Coordinate the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals for outside services.
- Care Path Development: Participate in the development of care paths to ensure seamless transitions and optimal care.
- Crisis Management: As an Intensive Case Manager, you will coordinate the care of a large caseload of high-risk patients and provide assessments and interventions in the community, including in-home visits. You will consult with internal and external physicians, healthcare providers, discharge planning, and outside agencies regarding continued care/treatment or hospitalization.
- Follow-up and Referrals: Arrange and monitor follow-up appointments, make referrals to appropriate community services, and identify opportunities for cost savings and quality of care improvements across the continuum.
- Data Collection and Analysis: Develop and collect reports and data, and trend utilization of healthcare resources to inform care decisions.
- Training and Communication: Develop and present in-service training and communication to both internal and external stakeholders.
- Regulatory Compliance: Interpret regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
- Clinical and Benefit Information: Coordinate the transmission of clinical and benefit information and treatment to patients, families, and outside agencies, including issuing Non-Coverage and Denial of Benefits letters consistent with Health Plan Regulations.
- Liaison and Coordination: Act as liaison to psychiatry clinics, outside agencies, non-plan facilities, and outside providers, and coordinate repatriation of patients and monitor their quality of care.
- Administrative Oversight: Provide administrative case management oversight to Inpatient Psychiatric Facilities, Crisis Residential Programs, and IMDs to ensure that services delivered to our members meet Kaiser's Quality and Utilization expectations and guidelines.
- On-Call and Documentation: Provide administrative on-call to the RSR/Sub regional Office and provide clinical and administrative documentation in accordance with Kaiser Regional Psychiatric Standards, including the Inpatient/Integrated Urgent Services Guidelines.
- Experience: Minimum two (2) years of experience in an inpatient psychiatric setting or psychiatric emergency service, and minimum two (2) years of experience in care management or clinical experience.
- Education: Masters degree (Social Work or Psychology), or PhD (Psychology) required.
- License, Certification, Registration: Psychologist License (California) OR Licensed Clinical Social Worker (California) OR Licensed Marriage and Family Therapist (California), and National Provider Identifier required at hire.
- Caseload Management: Responsibility for a large caseload for an extended period of time.
- Crisis Management Expertise: Demonstrated expertise in crisis management.
- Utilization Data Collection: Demonstrated experience in utilization data collection and cost benefit analysis.
- Regulatory Knowledge: Knowledge of TJC, and other local, state, and federal regulations.
- Labor Partnership Environment: Must be able to work in a Labor Partnership Environment.
