RN Case Manager Utilization Specialist
4 weeks ago
Kaiser Permanente seeks a skilled RN Case Manager Utilization Specialist to coordinate and screen for the appropriateness of admissions and continued stays. This role requires collaboration with physicians to make recommendations for alternate levels of care when patients do not meet medical necessity for inpatient hospitalization. The ideal candidate will interact with families, patients, and other disciplines to coordinate safe and acceptable discharge plans, functioning as an indirect caregiver, patient advocate, and manager of patients in the most cost-effective way without compromising quality.
Key Responsibilities:
- Develop and implement individualized plans of care to ensure continuity, quality, and appropriate resource use.
- Collaborate with physicians and other healthcare team members to assess and evaluate patient care.
- Recommend alternative levels of care and ensure compliance with federal, state, and local requirements.
- Assess high-risk patients in need of post-hospital care planning.
- Develop and coordinate discharge plans to meet patient needs.
- Communicate plans to physicians, patients, families, staff, and community agencies.
- Review, monitor, evaluate, and coordinate patient hospital stays to ensure timely and efficient delivery of essential services.
- Participate in bed huddles and implement recommendations congruent with patient needs.
- Coordinate interdisciplinary approaches to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations/approvals as needed.
- 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 patient transfers to appropriate facilities, maintaining and providing required documentation.
- Adhere to internal and external regulatory and accreditation requirements and compliance guidelines.
- Educate healthcare team members about their roles and responsibilities in discharge planning and resource utilization.
- Provide patients with education to assist with discharge and help cope with psychological problems related to acute and chronic illness.
- Report incidents of unusual occurrences related to quality, risk, and patient safety.
- Review, analyze, and identify utilization patterns and trends, participating in data collection and analysis 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.
Experience
- Two years combined RN experience in an acute care setting or case management required.
- Completion of an accredited RN training program that allows graduates to take RN license exam.
- Registered Nurse License (California)
- Basic Life Support
- Bachelor's degree in nursing or healthcare-related field.
- Alternating weekends
- Block Schedule
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