Inpatient Case Manager, Gwinnett Medical Offices, On Call
4 days ago
Responsible for working collaboratively with physician partners to optimize quality and efficiency of care for hospitalized members by carrying out daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care, developing a safe discharge plan to include recommending alternative levels and sites of care when appropriate. The activities will include daily review of hospital care by chart review and discussion with attending physician, admission and concurrent review for inpatient admissions, meetings with patient and families to develop discharge planning, identification of patients for ambulatory case management, communication with case managers, home care reviewers, social workers, members and providers, quality improvement reviews, and education of the member/family, provider and hospital staff. Achieves desired utilization and quality outcomes and promotes high customer satisfaction to the population served.
Essential Responsibilities:
- Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use. Reviews, monitors, evaluates and coordinates the patients hospital stay to assure that all appropriate and essential services are delivered timely and efficiently. Communicates via huddles with hospitalist partner multiple times throughout the day.
- Reviews all new inpatient admissions within 24 hours and begins the discharge planning process immediately. Assesses high risk patients in need of post-hospital care planning. Develops and coordinates the implementation of a discharge plan to meet each patients identified needs; communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies to enhance the effect of a seamless transition from one level of care to another across the continuum. Ensures that the appropriate level of care is being delivered in the most appropriate setting. Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
- Performs psychosocial assessments on all patients that meet the high risk indicators for discharge planning. Comprehensively assesses patients goals as well as their biophysical, psychosocial, environmental, economic/financial, and discharge planning needs. Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness. Refers patients to the ambulatory case managers, care managers and/or social workers as appropriate. Documents all admissions and discharges in the patients Kaiser Permanente electronic medical record. Makes post discharge follow-up calls to all patients who are not referred to an ambulatory case/care management program.
- Attends scheduled rounds 2 times/week with the Physician Director of Resource Stewardship to discuss clinical course and discharge planning for assigned patients identifying any real or potential delays in care or quality of care issues.
- Acts as a liaison between inpatient facility and referral facilities/agencies and provides case management to patients referred, serving as an advocate for patients and families. Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation. Builds highly effective working relationships with physicians, SNF staff, vendors, and other departments within the health plan.
Experience
- Minimum two (2) years of RN experience in patient care delivery or completion of Masters degree in Case Management Program in lieu of minimum years of experience.
- Associates Degree Nursing.
- Registered Professional Nurse License (Georgia)
- Demonstrated advanced communication and interpersonal skills with all levels of internal & external customers, including but not limited to medical staff, patients and families, clinical personnel, support and technical staff, outside agencies, and members of the community.
- Ability to collaborate effectively with multidisciplinary healthcare team.
- Excellent time management skills with the ability to work successfully in a fast-paced environment. Must be self-directed, and have the ability to tolerate frequent interruptions and a demanding work load.
- Functional knowledge of computers.
- Experience with managed health care delivery including Medicare.
- Experience in a payer environment highly desirable.
- Knowledge of funding, resources, services, clinical standards, and outcomes is preferred.
- 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 healthcare benefits associated with various business lines.
- Minimum five (5) years of clinical nursing experience in a hospital setting.
- Minimum five (5) years of professional practice experience in an acute care setting.
- Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
- Bachelors Degree in Nursing, Health Care or Masters degree in Case Management.
- Complex Case Management Certification preferred.
Primary Location: Georgia,Duluth,Gwinnett Medical Offices I
Scheduled Weekly Hours: 1
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 10:00 AM
Working Hours End: 10:30 PM
Job Schedule: Call-in/On-Call
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: NUE-GA-01|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Regional Office - 9 Piedmont - Med Adm-Cont Care Extrnl Svcs - 2808
Pay Range: $39.23 - $50.76 / hour Kaiser Permanente is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills and geographic location along with a review of current employees in similar roles to ensure that pay equity is achieved and maintained across Kaiser Permanente.
Travel: Yes, 100 % of the Time
On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
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Duluth, GA, United States Kaiser Permanente Full timeJob Summary: Responsible for working collaboratively with physician partners to optimize quality and efficiency of care for hospitalized members by carrying out daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care, developing a safe discharge plan to include recommending alternative levels and sites of care...
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