Case Manager Utilization RN

2 weeks ago

Ramona, California, United States Kaiser Full time
Job Summary

Kaiser Permanente is seeking a skilled Case Manager Utilization RN to join our team. As a key member of our healthcare team, you will play a critical role in coordinating and managing the care of our patients.

Key Responsibilities
  • Collaborate with Physicians: Work closely with physicians to coordinate and screen for the appropriateness of admissions and continued stays.
  • Coordinate Care: Interact with patients, families, and other healthcare disciplines to coordinate safe and acceptable discharge plans.
  • Manage Utilization: Function as an indirect caregiver, patient advocate, and manage patients in the most cost-effective way without compromising quality.
  • Comply with Regulations: Comply with AB 1203, Post Stabilization notification, and other regulatory requirements.
  • Communicate Effectively: Communicate with patients, families, and healthcare teams to ensure continuity of care.
  • Monitor and Evaluate: Review, monitor, evaluate, and coordinate patients' hospital stays to ensure timely and efficient delivery of essential services.
  • Participate in Bed Huddles: Participate in Bed Huddles and carry out recommendations congruent with patients' needs.
  • Coordinate Interdisciplinary Care: Coordinate the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations/approvals as needed.
  • Conduct Clinical Reviews: Conduct daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in various settings.
  • Liaise with Referral Facilities: Act as a liaison between in-patient facilities and referral facilities/agencies and provide case management to patients referred.
  • Refer to Community Resources: Refer patients to community resources to meet post-hospital needs.
  • Coordinate Transfers: Coordinate transfers of patients to appropriate facilities and maintain required documentation.
  • Adhere to Regulatory Requirements: Adhere to internal and external regulatory and accreditation requirements and compliance guidelines.
  • Educate Healthcare Teams: Educate members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
  • Provide Patient Education: Provide patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
  • Report Incidents: Report any incidents of unusual occurrences related to quality, risk, and/or patient safety.
  • Review and Analyze Utilization Patterns: Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources.
  • Participate in Committees: Participate in committees, teams, or other work projects/duties as assigned.
Requirements
  • Experience: Two (2) years combined RN experience in an acute care setting or case management required.
  • Education: Completion of an accredited RN training program that allows graduates to take RN license exam.
  • License, Certification, Registration: Registered Nurse License (California) and Basic Life Support.
  • 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: Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
  • Communication Skills: Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking, and problem-solving skills.
  • Planning and Organizing Skills: Demonstrated ability in planning, organizing, conflict resolution, and negotiating skills.
  • Computer Literacy: Computer literacy skills required.
  • Preferred Qualifications: Bachelor's degree in nursing or healthcare-related field.

  • Pharmacy Operations Manager

    4 weeks ago

    Ramona, California, United States CVS Health Full time

    Join CVS HealthAt CVS Health, we are united by a clear mission: to enhance the health of our communities. Our commitment is to provide a human-centered approach to healthcare that adapts to the evolving needs of our patients.Our core values guide our actions, emphasizing that the manner in which we deliver our services is as crucial as the services...

  • Clinical Nurse Specialist

    4 weeks ago

    Ramona, California, United States Core Civic Full time

    Salary Range: $100,000-$175,000 per year At Corecivic, we prioritize more than just managing individuals; we are dedicated to providing compassionate care. We are currently seeking Advanced Registered Nurses who are committed to delivering exceptional healthcare in a correctional environment. The Advanced Registered Nurse Practitioner, under the guidance...

  • Advanced Nurse Practitioner

    4 weeks ago

    Ramona, California, United States Core Civic Full time

    Salary Range: $100,000-$175,000 per year At Corecivic, we prioritize the well-being of individuals in our care. We are currently seeking Advanced Registered Nurses who are dedicated to delivering exceptional healthcare services within a correctional environment. The Advanced Registered Nurse Practitioner, under the guidance of the facility's physician, is...

  • Nurse Leader

    1 week ago

    Ramona, California, United States Kaiser Full time

    Job SummaryWe are seeking a skilled Registered Nurse to join our team as a leader in the healthcare team. As a key member of our team, you will provide professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures.ResponsibilitiesDevelop and implement individualized plans of care that...

  • Retail Sales Associate

    4 weeks ago

    Ramona, California, United States Goodwill Industries of San Diego County Full time

    About Goodwill Industries of San Diego County:Are you passionate about making a positive impact in your community? At Goodwill, we are dedicated to our Core Values of Creativity, Credibility, and Collaboration. As a mission-driven organization, we utilize the sale of donated goods to fund essential job training and employment opportunities for individuals...

  • Lead Pharmacist

    4 weeks ago

    Ramona, California, United States CVS Health Full time

    Join CVS Health as a Pharmacy ManagerAt CVS Health, we are dedicated to enhancing health care through a human-centric approach. Our mission is clear: Bringing our heart to every moment of your health. This commitment shapes our culture and the way we serve our patients.Position Overview:As a Pharmacy Manager, you will play a pivotal role in our organization,...

  • Veterinary Care Specialist

    3 weeks ago

    Ramona, California, United States VCA Animal Hospitals Full time

    Veterinary Technician Role at VCA Animal HospitalsVCA Animal Hospitals is seeking a skilled veterinary technician to join our team of dedicated professionals. Our practice prioritizes high-quality medicine and surgery in a compassionate environment. We offer competitive compensation and benefits, including medical insurance, 401(k) plan, paid time off, and...

  • Veterinary Care Specialist

    3 weeks ago

    Ramona, California, United States VCA Animal Hospitals Full time

    Veterinary Technician Role at VCA Animal HospitalsVCA Animal Hospitals is seeking a skilled veterinary technician to join our team of dedicated professionals. Our practice prioritizes high-quality medicine and surgery in a compassionate environment. We offer competitive compensation and benefits, including medical insurance, 401(k) plan, paid time off, and...

  • Maintenance Supervisor

    3 weeks ago

    Ramona, California, United States Hilton Grand Vacations Full time

    Job Overview Become a part of a dynamic team that provides Day One Benefits, Daily Pay, and exceptional perks. This is a remarkable opportunity to work with a thriving organization. We are thrilled to present this exceptional opportunity for you to become a vital member of our outstanding team at a premier resort. Our welcoming culture fosters an...

  • Maintenance Supervisor

    4 weeks ago

    Ramona, California, United States Hilton Grand Vacations Full time

    Job Overview Become part of a dynamic team that offers immediate benefits, competitive pay, and exceptional perks. This is a remarkable opportunity to work with a thriving organization. We are thrilled to present this distinctive opportunity for you to become a member of our outstanding team at a premier resort. Our welcoming culture will embrace you...

  • Case Manager Utilization RN, 40/hr Night

    3 weeks ago

    Ramona, United States Kaiser Full time

    Sign On Bonus for Eligible External Hires Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family,...

  • Case Manager Utilization RN, 40/hr Night

    4 weeks ago

    Ramona, CA, United States Kaiser Full time

    Sign On Bonus for Eligible External Hires Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family,...

  • RN Case Manager Registered Nurse

    4 weeks ago

    Ramona, United States AccentCare Full time

    OverviewStart of Care (SOC) - $155 Resumption of Care (ROC) - $130 Recertification - $130 Evaluation - $100 Find Your Passion and Purpose as an RN Case Manager. Reimagine Your Career in Home Health As a medical professional, you know that what you do impacts you as much as your patients and their families, and at AccentCare, we are united in our relentless...

  • School Nurse

    2 months ago

    Ramona, United States Pioneer Healthcare Services Full time

    Pioneer Healthcare Services has an exciting opportunity for a Licensed Vocational / Practical Nurse LVN LPN. A school district in Ramona, CA is looking for dedicated School Nurse Licensed Vocational / Practical Nurse LVN/ LPN to join their team for the 2024 - 2025 school year with the possibility to extend. School Licensed Vocational / Practical Nurses LVN...

  • School Nurse

    2 months ago

    Ramona, United States Pioneer Healthcare Services Full time

    Pioneer Healthcare Services has an exciting opportunity for a Part-Time Licensed Vocational / Practical Nurse LVN LPN. A school district in Ramona, CA is looking for dedicated School Nurse Licensed Vocational / Practical Nurse LVN/ LPN to join their team for the 2024 - 2025 school year with the possibility to extend. School Licensed Vocational / Practical...

  • Angiogram/Interventional Technologist

    3 weeks ago

    Ramona, United States Kaiser Full time

    Job Summary: Under the indirect supervision, provides patient services using imaging modalities. Performs a variety of angio interventional procedures on patients of all ages. Evaluates images for technical quality. Exercises professional attitude and judgment in the performance of duties. Provides patient care essential to angio interventional procedures....

  • Program Administrator

    3 weeks ago

    Ramona, United States YAI Full time

    Job DescriptionJob DescriptionKey/Essential Functions & ResponsibilitiesOversees the milieu and therapeutic programming of the assigned program, including the development and implementation of therapeutic programming and groups by the interdisciplinary team.Ensures the appropriate, therapeutically documented level of supervision in the assigned program at...

  • Direct Support Professional

    2 months ago

    Ramona, United States YAI Full time

    Job DescriptionJob DescriptionKey/Essential Functions & ResponsibilitiesResponsible for the overall supervision, protection, and care of the individual at all times including maintenance of house rules for the protection of individuals, facilitating learning and training in fire safety and identifying and appropriately escalating signs of an individual’s...

  • Surgical Technologist II

    3 weeks ago

    Ramona, CA, United States Kaiser Full time

    $2,000 sign on bonus eligible position! Job Summary: Under close supervision, assists during surgery as a member of the surgical team by preparing and organizing operating room prior to surgery, selecting and passing instruments during surgical procedures, maintaining operating room in aseptic condition following established policies and procedures; and...

  • Clinical Nurse Specialist, RN Sign On Bonus Available

    4 weeks ago

    Ramona, CA, United States Kaiser Full time

    Eligible up to 10% of Annual Salary Sign on Bonus Job Summary: The Clinical Nurse Specialist role at Kaiser Permanente Southern California Region is a clinical manager who partners with the operational manager to ensure that nursing staff delivers safe and effective care. The role is built around the five role subcomponents as regulated by the California...