Case Manager Continuing Care Specialist

1 month ago

Downey, California, United States Kaiser Permanente Full time
Job Summary:

As a key member of our healthcare team, the Case Manager Continuing Care SW PD will play a vital role in coordinating patient care and population-based management for patients in specifically defined geriatric or other specifically defined patient populations. This includes planning and implementing a comprehensive, multi-disciplinary approach to manage health conditions, utilization of resources and protocols, patient self-care, and implementation and evaluation of treatment plans across the care continuum. In conjunction with physicians, the Case Manager will develop treatment plans, monitor care, make recommendations for alternative levels of care, identify cost-effective protocols and care paths, and develop guidelines for care that may require coordination across systems of multiple providers/services.

Essential Responsibilities:
  • Develops and implements individualized patient care plans to ensure optimal health outcomes.
  • Collaborates with primary care and specialist physicians to evaluate and develop baseline medical and psychosocial evaluations and individualized patient care/treatment plans.
  • Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
  • Conducts assessments of physiological and functional status utilizing established protocols.
  • Initiates diagnostic testing and interventions as needed.
  • Develops and delivers patient/family education plans focused on self-management and disease-specific education.
  • Implements strategies to target and assess risk factors and achieve patient follow-up according to clinical and strategic measures/outcomes.
  • Produces population-based reports on outcomes specific to defined patient populations.
  • Participates in healthcare team decision-making to achieve predetermined cost, clinical, quality, utilization, and service outcomes.
  • Develops and maintains case management policies and procedures.
  • Coordinates care/services with utilization and/or quality reviewers and monitors level and quality of care.
  • Coordinates interdisciplinary care approaches to provide continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations/approvals/transfers as needed for outside services.
  • Consults with internal and external physicians, healthcare providers, discharge planning, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
  • Arranges and monitors follow-up appointments.
  • Encourages members to follow prescribed courses of care.
  • Makes referrals to appropriate community services and outside providers.
  • Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
  • Develops and collects data; trends utilization of healthcare resources.
  • Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
  • Coordinates transmission of clinical and benefit treatment to patients, families, and outside agencies.
  • Acts as liaison for outside agencies, non-plan facilities, and outside providers.
  • Coordinates repatriation of patients and monitors their quality of care.
Basic Qualifications:

  • Graduate of an academic institution accredited by the Council on Social Work Education and a Master's degree in Social Work.
Additional Requirements:
  • Demonstrated knowledge of case management, discharge planning, transfer coordination; TJC and other federal/state/local regulations.
  • Ability to work in a Labor/Management Partnership environment.
Preferred Qualifications:
  • Minimum two (2) years of case management experience with the population to be case managed.
  • Current and valid LCSW highly preferred.
  • Two (2) years of case management experience.
  • LCSW highly preferred.
  • Knowledge of psychiatric diagnoses/treatment for children, adolescents, and adults.

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