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Registered Nurse Case Manager
2 months ago
Job Summary:
Kaiser Permanente is seeking a Registered Nurse (RN) Case Manager to coordinate patient care and develop plans of care in a nursing job in Hawaii.
Key Responsibilities:
- Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care.
- Develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care.
- Performs daily pre-admission, admission, and concurrent utilization reviews to determine appropriate levels of care and readiness for discharge.
- Escalates utilization and system problems which have not been resolved immediately.
- Performs rounds and reviews patient admissions under Kaiser Skilled Nursing Facility (SNF) benefit.
- Utilizes knowledge and experience of Medicare regulations and Health Plan benefits to determine medical necessity.
- Monitors the progression of the plan of care and facilitates discussions with the multidisciplinary teams.
- Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care.
- Ensures continuity of care for outside services for the patient.
- Monitors level of care.
- Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies.
- Monitors care processes and participates in the development and implementation of guidelines, pre-printed physician orders, care paths, etc. for patient care.
- Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum.
- Establishes and maintains effective relationships between Kaiser Permanente and the community facilities.
- Identifies quality improvement and relationship building opportunities.
- Monitors high-cost cases and reports findings to Hospital Administration, Director of Continuing Care and/or Community Medical Services.
- Keeps abreast of current changes in health care benefits, laws or regulatory requirements which influence health plan benefit issues.
- May perform patient care to the extent necessary to maintain clinical expertise, competency, and licensing necessary to fulfill job responsibilities and to direct the provision of care on the unit.
- Provides direct patient care on an as needed basis.
- Provides services that are within scope of license and in compliance with all legal, regulatory, and policy requirements relevant to clinical role performed.
- Incorporates the KP Nursing Vision, Model and Values throughout their Nursing Practice.
Requirements:
- Four (4) years of acute or sub-acute inpatient care experience.
- One (1) year of Care Management experience OR successful completion of the MHS Case Management Internship within 6 months of hire.
- Bachelors degree in nursing OR four (4) years of directly related experience.
- License, Certification, Registration
- Demonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.
- Analytical and interpretive ability of data in daily operations.
- Minimum two (2) years of experience in Care Management.
- Professional certification in Case Management.
- Masters Degree in health care administration, nursing, or related field.
