RN Case Manager Specialty

5 days ago

Riverside, California, United States Kaiser Permanente Full time
Job Summary

We are seeking a skilled RN Case Manager to join our team at Kaiser Permanente. As a key member of our multidisciplinary team, you will work collaboratively with physicians to manage patients' specialized needs. Your expertise will be essential in assessing patient needs, developing care management plans, and coordinating access to health services across multiple providers and disciplines.

Key Responsibilities
  • Evaluate and identify members' needs, working closely with primary care physicians, specialists, and various disciplines to develop case management plans and programs.
  • Monitor and evaluate the effectiveness of case management plans, making modifications as necessary to ensure optimal patient outcomes.
  • Coordinate the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining necessary authorizations and approvals.
  • Act as a clinical liaison with outside agencies, such as County CCS, non-plan facilities, and third-party administrators, to ensure seamless care coordination.
  • Prepare reports, communicate program changes to staff, and develop protocols in accordance with state regulations.
  • Advocate for patients, educating them on self-management and empowering them to take an active role in their care.
  • Develop individualized patient education plans, delivering education specific to disease states and facilitating patients' return to normal daily activities.
  • Consult with internal and external physicians, healthcare providers, discharge planners, and outside agencies regarding continued care, treatment, or hospitalization.
  • May facilitate transportation and housing arrangements for patients, coordinating transmission of clinical and benefit information to patients, families, and outside agencies.
  • Participate in data collection and analysis of clinical outcomes and customer satisfaction standards, contributing to the formulation and implementation of action strategies and outcomes.
Requirements
  • Minimum two years of clinical experience as an RN in an acute care or ambulatory care setting.
  • Bachelor's degree or equivalent experience.
  • Current California RN license and BLS certification required.
  • Demonstrated ability to utilize and apply principles, practices, techniques, and methods of utilization review/management, care coordination, transfer coordination, discharge planning, or case management.
  • Working knowledge of regulatory requirements and accreditation standards.
  • Computer literacy skills and bilingual (English/Spanish) QBS Level II required.
Preferred Qualifications
  • Bachelor's degree in nursing or healthcare-related field.
  • Case Management Certification or certification in the area of specialty.

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