RN Utilization Case Manager

4 weeks ago

Glendale, California, United States Kaiser Full time
Job Summary:

Kaiser Permanente is seeking a skilled RN Utilization Case Manager to join our team at West Los Angeles Medical Center. As a key member of our Utilization Management team, you will play a critical role in coordinating and screening patient admissions and continued stays, making recommendations to physicians for alternate levels of care, and interacting with patients, families, and other disciplines to coordinate safe and acceptable discharge plans.

Essential 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 develop, implement, and document plans of care.
  • Assess high-risk patients in need of post-hospital care planning and develop and coordinate discharge plans to meet their identified needs.
  • Communicate plans to physicians, patients, families/caregivers, staff, and community agencies.
  • Review, monitor, evaluate, and coordinate patients' hospital stays to ensure timely and efficient delivery of essential services.
  • Participate in Bed Huddles and carry out recommendations congruent with patients' needs.
  • Coordinate interdisciplinary approaches to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations/approvals as needed for outside services.
  • 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 facilities/agencies, providing case management to patients referred.
  • Refer patients to community resources to meet post-hospital needs.
  • Coordinate transfers of patients to appropriate facilities, maintaining and providing required documentation.
  • Adhere to internal and external regulatory and accreditation requirements and compliance guidelines.
  • Educate healthcare team members concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
  • Provide patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
  • Report any incidence of unusual occurrences related to quality, risk, and/or patient safety identified during case review or other activities.
  • Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources, participating in the collection and analysis of data for special studies, projects, planning, or routine utilization monitoring activities.
  • Coordinate, participate in, or facilitate care planning rounds and patient family conferences as needed.
  • Participate in committees, teams, or other work projects/duties as assigned.
Basic Qualifications:
  • Two (2) years combined RN experience in an acute care setting or case management required.
Additional Requirements:
  • 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.
Preferred Qualifications:
  • Bachelor's degree in nursing or healthcare-related field.
Notes:
  • Every other weekend.

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