Patient Care Coordinator Case Manager

1 week ago

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

As a Patient Care Coordinator Case Manager at Kaiser Permanente, you will play a vital role in coordinating with physicians, staff, and non-Kaiser providers and facilities regarding patient transitions and discharge planning. In conjunction with physicians, you will develop plans of care and discharge plans, and make recommendations for alternative levels of care as required. Your expertise will be essential in ensuring continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning, and obtaining authorizations/approvals as needed for outside services for the patient.
Essential Responsibilities:
  • Utilization Management: Conduct daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.
  • Monitor the progression of the discharge plan and facilitate discussions with the multidisciplinary teams.
  • Educate other healthcare team members on utilization and care coordination.
  • Collaborate with and provide information to patients, families, physicians, and staff regarding the discharge plans and transitions.
  • Understand and consistently apply the interpretation, and utilization of member health care benefits.
  • Conduct UM, care coordination, and discharge planning activities according to all applicable regulatory requirements.
  • Discharge Planning: Ensure continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning, and obtaining authorizations/approvals as needed for outside services for the patient.
  • Develop, evaluate, and coordinate a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies.
  • Regulatory: Conduct UM, care coordination, and discharge planning activities according to all applicable regulatory requirements.
  • Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.
Basic Qualifications:

Experience
  • Minimum four (4) years of experience in hospital patient care delivery, OR completion of Masters degree in case management program in lieu of minimum years of experience.
Education
  • Graduate of accredited school of nursing.
  • Diploma/Associate Degree Nursing.
License, Certification, Registration
  • Registered Nurse License (California).
  • Basic Life Support.
Additional Requirements:
  • Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations.
  • Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
  • Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations.
  • Knowledge of health care benefits associated with various business line (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).
  • Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
  • Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
  • Bachelors degree in nursing or a health care related field preferred.
  • Masters degree in case management preferred.

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