Case Manager Utilization RN

4 weeks ago


Downey, California, United States Kaiser Permanente Full time
Job Summary:
As a Case Manager Utilization RN at Kaiser Permanente, you will work collaboratively with physicians to coordinate and screen for the appropriateness of admissions and continued stays. You will make recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for inpatient hospitalization. You will interact with the family, patient, and other disciplines to coordinate a safe and acceptable discharge plan. You will function as an indirect caregiver, patient advocate, and manage patients in the most cost-effective way without compromising quality. You will transfer stable non-members to planned healthcare facilities. You will be responsible for complying with AB 1203, Post Stabilization notification. You will comply with other duties as described. You must be able to work collaboratively with the multidisciplinary team, multitask, and in a fast-paced environment.

Essential Responsibilities:
Plans, develops, assesses, and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary healthcare team, and patient/family in the development, implementation, and documentation of appropriate, individualized plans of care to ensure continuity, quality, and appropriate resource use. Recommends alternative levels of care and ensures compliance with federal, state, and local requirements. Assesses high-risk patients in need of post-hospital care planning. Develops and coordinates the implementation of a discharge plan to meet patients' identified needs. Communicates the plan to physicians, patient, family/caregivers, staff, and appropriate community agencies. Reviews, monitors, evaluates, and coordinates the patients' hospital stay to assure that all appropriate and essential services are delivered timely and efficiently. Participates in the Bed Huddles and carries out recommendations congruent with the patients' needs. Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families. Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient, and non-KFH facilities. Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred. Refers patients to community resources to meet post-hospital needs. Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation. Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA, and DOL. Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources. Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness. Per established protocols, reports any incidence of unusual occurrences related to quality, risk, and/or patient safety which are identified during case review or other activities. Reviews, analyzes, and identifies utilization patterns and trends, problems, or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities. Coordinates, participates, and/or facilitates care planning rounds and patient family conferences as needed. Participates in committees, teams, or other work projects/duties as assigned.

  • Downey, California, United States Kaiser Permanente Full time

    Job Summary:As a Utilization Review and Management RN at Kaiser Permanente, you will work collaboratively with physicians to coordinate and screen for the appropriateness of admissions and continued stays. You will make recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for inpatient...

  • Nurse Case Manager

    4 weeks ago


    Downey, California, United States Kaiser Permanente Full time

    Kaiser Permanente is seeking a skilled Registered Nurse to fill a Case Management position. The ideal candidate will have experience in acute care settings and a strong understanding of case management principles.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNDuration: Ongoing1 hours per weekShift: 8 hours, daysEmployment Type: Staff...


  • Downey, California, United States Kaiser Permanente Full time

    Kaiser Permanente is seeking an RN Utilization Specialist to work collaboratively with medical directors to coordinate and screen for the appropriateness of admissions and Continued stays. Key responsibilities include making recommendations to physicians for alternate levels of care when patients do not meet medical necessity for Inpatient hospitalization,...

  • Registered Nurse

    1 month ago


    Downey, California, United States Kaiser Permanente Full time

    Job SummaryKaiser Permanente is seeking a skilled Registered Nurse to join our team as a Case Manager. In this role, you will work collaboratively with physicians to coordinate and screen for the appropriateness of admissions and continued stays. You will make recommendations to physicians for alternate levels of care when patients do not meet the medical...


  • Downey, California, United States Titan Medical Full time

    Job Title: Travel Case Management RNJob Summary: We are seeking a skilled Travel Case Management RN to join our team at Titan Medical. As a Travel Case Management RN, you will be responsible for providing high-quality patient care and case management services to patients in various healthcare settings.Responsibilities:Provide case management services to...


  • Downey, California, United States Titan Medical Full time

    Job Title: Travel Case Management RNJob Summary: We are seeking a skilled Travel Case Management RN to join our team at Titan Medical. As a Travel Case Management RN, you will be responsible for providing high-quality patient care and case management services to patients in various healthcare settings.Responsibilities:Provide case management services to...

  • Clinical Case Manager

    1 month ago


    Downey, California, United States Kaiser Permanente Full time

    Job Summary:As a Clinical Case Manager at Kaiser Permanente, you will work collaboratively with physicians to coordinate and screen for the appropriateness of admissions and continued stays. You will make recommendations to physicians for alternate levels of care when patients do not meet medical necessity for inpatient hospitalization. You will interact...


  • Downey, California, United States KPG Healthcare Full time

    Job Title: Travel Nurse RN Case ManagerJob Description:KPG Healthcare is seeking a travel nurse RN Case Management for a travel nursing job. The ideal candidate will have two years of experience in the last three years of this specialty to qualify.Job Requirements:- 2 years of experience in the last 3 years of this specialty- Competitive compensation...


  • Downey, California, United States MedPro Healthcare Staffing Full time

    MedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job. The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patient's family and healthcare organization.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNEmployment Type:...


  • Downey, California, United States PRIDE Health Full time

    PRIDE Health is seeking a skilled travel nurse RN case manager to join their team. This exciting opportunity offers a chance to work with a leading healthcare organization and make a meaningful impact in the lives of patients.Job DetailsSpecialty: Case ManagementJob Type: Travel NursingLocation: Downey, CaliforniaDuration: 13 weeksHours: 40 hours per...


  • Downey, California, United States Kaiser Permanente Full time

    Job Summary:As a Case Manager Continuing Care Specialist at Kaiser Permanente, you will play a critical role in coordinating patient care and population-based management for patients in defined geriatric or other patient populations. Your comprehensive approach will involve working with physicians, staff, and non-Kaiser providers to plan and implement...


  • Downey, California, United States MedPro Healthcare Staffing Full time

    Job Title: Travel Nurse RN Case Manager PositionJob Description:MedPro Healthcare Staffing is seeking a skilled travel nurse RN case manager to fill a challenging and rewarding position in a top healthcare facility. As a case manager, you will play a crucial role in coordinating continuity of care for patients, often serving as a liaison between the...


  • Downey, California, United States PRIDE Health Full time

    PRIDE Health is seeking a travel nurse RN Case Management professional for a travel nursing assignment in California. Job Details Specialty: Case Management Discipline: RN Assignment Length: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel PRIDE Health is a leading healthcare recruitment division that connects travel nurses with top...


  • Downey, California, United States IDR Healthcare Full time

    Job Title: Travel Nurse RN Case ManagerIDR Healthcare is seeking a travel nurse RN case manager for a travel nursing job in Downey, California.Specialty: Case ManagementDiscipline: RNDuration: 13 weeksShift: 12 hours, daysEmployment Type: TravelIDR Healthcare is an award-winning staffing firm that believes it is a privilege and awesome responsibility to...


  • Downey, California, United States Ardor Health Solutions Full time

    Ardor Health Solutions is seeking a travel nurse RN Case Management professional to fill a challenging and rewarding travel nursing job in California.Job DetailsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelArdor Health Solutions is a reputable medical staffing business with a long history of providing excellent pay packages, benefits, and...

  • Medical Case Manager

    4 weeks ago


    Downey, California, United States Kaiser Permanente Full time

    At Kaiser Permanente, we're committed to advancing health equity and addressing the social determinants of health. As a Medical Case Manager, you'll play a critical role in our efforts to provide high-quality, patient-centered care to our diverse patient population.The ideal candidate will have 2+ years of experience in an acute care setting or case...


  • Downey, California, United States PIH Health Full time

    At PIH Health, we are seeking a skilled Registered Nurse to fill the role of Case Manager. This position is responsible for managing a continuum of care for assigned patients, from pre-admission through post-discharge. The ideal candidate will have a broad knowledge of disease processes, pathophysiology, and treatment plans, as well as strong assessment...


  • Downey, California, United States AMN Healthcare Full time

    Job DetailsPosition SummaryWe are seeking a highly skilled RN Case Manager to join our team. As an RN Case Manager, you will work in an acute care setting and have the opportunity to make a meaningful impact on patients' lives.Responsibilities:Manage OB postpartum hypertension patients by collecting blood pressure information, reviewing providers, and...


  • Downey, California, United States IDR Healthcare Full time

    IDR Healthcare is seeking a travel nurse to fill a Case Management position. This is a travel nursing job in California.Job Description & RequirementsSpecialty: Case Management Discipline: RN Employment Type: Travel IDR Healthcare is an award-winning staffing firm that believes it is a privilege and awesome responsibility to serve those who selflessly care...

  • ICMS Case Manager

    1 month ago


    Downey, California, United States The Whole Child - Mental Health & Housing Services Full time

    Job DescriptionAt The Whole Child - Mental Health & Housing Services, we are seeking a highly skilled ICMS Case Manager to join our team. As a key member of our Family Housing Program, you will play a vital role in supporting families in achieving transitional housing and accessing necessary community services.Key Responsibilities:Conduct comprehensive needs...