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RN, Inpatient Case Manager, On-Call, Kaiser Permanente
1 month ago
As an Inpatient Case Manager, RN with Kaiser Permanente, you will play a vital role in optimizing the quality and efficiency of care for hospitalized members. Collaborating with physician partners, you will conduct daily utilization and quality reviews, identify inefficiencies, and develop safe discharge plans. Your responsibilities will include reviewing hospital care through chart review and discussion with attending physicians, admission and concurrent review for inpatient admissions, and meetings with patients and families to develop discharge planning. You will also identify patients for ambulatory case management, communicate with case managers, home care reviewers, social workers, members, and providers, and participate in quality improvement reviews and education of the member/family, provider, and hospital staff. Achieving desired utilization and quality outcomes and promoting high customer satisfaction to the population served is essential.
Essential Responsibilities:
- Develop, implement, and document individualized plans of care to ensure continuity, quality, and appropriate resource use. Collaborate with physicians, other healthcare team members, and patients/families to achieve this goal.
- Review all new inpatient admissions within 24 hours and initiate discharge planning. Assess high-risk patients in need of post-hospital care planning and develop and coordinate the implementation of a discharge plan to meet each patient's identified needs.
- Perform psychosocial assessments on patients meeting high-risk indicators for discharge planning. Assess patients' goals, biophysical, psychosocial, environmental, economic/financial, and discharge planning needs. Provide education to assist with discharge and help patients cope with psychological problems related to acute and chronic illness.
- Refer patients to ambulatory case managers, care managers, and/or social workers as appropriate. Document all admissions and discharges in the patient's Kaiser Permanente electronic medical record.
- Attend scheduled rounds with the Physician Director of Resource Stewardship to discuss clinical course and discharge planning for assigned patients, identifying any real or potential delays in care or quality of care issues.
- Act as a liaison between inpatient facilities and referral facilities/agencies, providing case management to patients referred and serving as an advocate for patients and families. Coordinate transfers of patients to appropriate facilities and maintain required documentation.
Experience
- Minimum two (2) years of experience in patient care delivery or completion of a Master's degree in Case Management in lieu of minimum years of experience.
- Associates Degree in Nursing.
- Registered Professional Nurse License (Georgia)
- Licensed Registered Nurse (Temporary - Georgia)
- Demonstrated advanced communication and interpersonal skills with all levels of internal and external customers, including medical staff, patients and families, clinical personnel, support and technical staff, outside agencies, and members of the community.
- Ability to collaborate effectively with a multidisciplinary healthcare team.
- Excellent time management skills with the ability to work successfully in a fast-paced environment. Must be self-directed and able to tolerate frequent interruptions and a demanding workload.
- Functional knowledge of computers.
- Experience with managed healthcare delivery, including Medicare.
- Experience in a payer environment highly desirable.
- Knowledge of funding, resources, services, clinical standards, and outcomes is preferred.
- Complex Case Management Certification preferred.
- Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPAA, ERISA, EMTALA, and all other applicable federal/state/local laws and regulations.
- Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgment abilities.
- Fundamental word processing and computer navigation skills and the ability to interpret and use analytic data in day-to-day operations.
- Knowledge of healthcare benefits associated with various business lines.
- Minimum five (5) years of clinical nursing experience in a hospital setting.
- Minimum five (5) years of professional practice experience in an acute care setting.
- Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
- Bachelor's Degree in Nursing, Healthcare, or Master's degree in Case Management.
