Case Management Specialist RN
3 weeks ago
Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify member needs and development of specific care management plan to address needs. In conjunction with the Physician, implements care/treatment plan by coordinating access to health services across multiple providers/ disciplines, monitors care, makes determination to arrange transportation and transfer patient if indicated, identifies cost-effective measures, makes recommendations for alternative levels of care and utilization of resources, promotes self-care management and ensures paper work is completed. Is an indirect caregiver. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.
Essential Responsibilities:- Evaluates and identifies members needs. Interfaces with Primary Care Physicians, Specialists and various disciplines on the development of case management plans/programs.
- Monitors and evaluates the effectiveness of the case management plans and modifies as necessary.
- Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
- Acts as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers compensation carriers and third party administrators.
- Prepares reports, communicates program changes to appropriate staff and develops protocols in accordance with state regulations.
- Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care.
- Develops individualized patient/family education plan focused on self-management, delivers patient/family education specific to a disease state.
- Develops and updates training and educational materials and presents to appropriate staff, members and families. Facilitates patients return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
- Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
- May need to facilitate transportation and housing arrangements for patient. Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
- Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards. Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service. Ensures that accurate records are maintained of the care associated with each patient.
- Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.
Basic Qualifications:
Experience
- Minimum two (2) years clinical experience as an RN in an acute care or ambulatory care setting required.
Education
- Bachelors degree or equivalent experience four (4) years required.
License, Certification, Registration
- Registered Nurse License (California)
- Basic Life Support
Additional Requirements:
- Demonstrated ability to utilize/apply the general and specialized 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 (TJC, Medicare, Medi-Cal, etc.).
- Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills required.
- Computer literacy skills required.
- Bilingual (English/Spanish) Level II required.
Preferred Qualifications:
- Case Management Certification or certification in the area of specialty preferred.
- Bachelors degree in nursing or healthcare related field preferred.
Notes:
- Nephrology Case Manager
- Must successfully pass or have passed the bilingual test (within the last 12 months), or be active in the QBS program.
-
Case Management Specialist Rn
1 day ago
Fontana, United States Kaiser Permanente Full time**Job Summary**: Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify member needs and development of specific care management plan to address needs. In conjunction with the Physician, implements care/treatment...
-
Case Management Specialist RN
3 days ago
Fontana, CA, United States Kaiser Permanente Full timeJob Summary: Works collaboratively with an assigned panel of physicians to manage the patients specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify member needs and development of specific care management plan to address needs. In conjunction with the Physician, implements...
-
Lvn/lpn Case Manager Assistant
3 weeks ago
Fontana, United States Kaiser Permanente Full time**Job Summary**: The LVN/LPN Case Manager Assistant is responsible to conduct medical necessity screening and work collaboratively with the interdisciplinary team to provide care coordination for patients under the direction of a Registered Nurse and in compliance with evidence-based practice and regulatory requirements. This position complies with the scope...
-
Case Manager Utilization Rn- Per Diem Day
5 days ago
Fontana, United States Kaiser Permanente Full time**Job Summary**: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a...
-
Case Manager Utilization RN- Per Diem Day
3 days ago
Fontana, United States Kaiser Permanente Full timeJob Summary:Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a safe...
-
Fontana, United States Kaiser Permanente Full time**Sign On Bonus for Eligible External Hires** **Job Summary**: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family,...
-
Fontana, United States Kaiser Permanente Full timeOnsite at a KP contracted hospital in Victorville, CA Job Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the...
-
Marketing and Sales Specialist
2 weeks ago
Fontana, United States Instep Management Group Full timeWe have quickly become one of the fastest-growing sales and marketing firms in the Inland Empire business world. Due to increased client demand and recent expansions, we have several account executive positions open. The Marketing and Sales Specialist position is considered an entry-level position meaning thorough training is provided. We believe that our...
-
Fontana, CA, United States Kaiser Permanente Full timeJob Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a...
-
Fontana, CA, United States Kaiser Permanente Full timeJob Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a...
-
Case Manager Utilization RN- Per Diem Day
5 days ago
Fontana, United States Kaiser Permanente Full timeJob Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a...
-
Fontana, California, United States Kaiser Permanente Full timeJob Summary: Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a safe...
-
Target Security Specialist
5 days ago
Fontana, United States Target Full timeStarting Hourly Rate / Salario por Hora Inicial: $19.25 USD per hour **ALL ABOUT TARGET** Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. **ALL ABOUT ASSETS PROTECTION** Assets Protection (AP) teams function to keep our guests, team...
-
Bilingual PRS Intensive Case Manager Level 3
3 weeks ago
Fontana, United States National Youth Advocate Program Full timeJob DetailsJob Location Fontana, CA Job Category Nonprofit - Social Services Job Description This position is remote but requires in home visits across region 9. Travel may vary and the region covers California, Nevada, Arizona, and Hawaii. Applicants can be from any of these states since the position is remote. Position Title: PRS Intensive Case Manager...
-
Bilingual PRS Intensive Case Manager Level 3
2 weeks ago
Fontana, United States National Youth Advocate Program Full timeJob DetailsJob Location Fontana, CA Job Category Nonprofit - Social Services Job Description This position is remote but requires in home visits across region 9. Travel may vary and the region covers California, Nevada, Arizona, and Hawaii. Applicants can be from any of these states since the position is remote. Position Title: PRS Intensive Case Manager...
-
Bilingual PRS Intensive Case Manager Level 3
1 week ago
Fontana, United States National Youth Advocate Program Full timeJob DetailsJob Location Fontana, CA Job Category Nonprofit - Social Services Job Description This position is remote but requires in home visits across region 9. Travel may vary and the region covers California, Nevada, Arizona, and Hawaii. Applicants can be from any of these states since the position is remote. Position Title: PRS Intensive Case Manager...
-
Manager Utilization Management
2 months ago
Fontana, United States Kaiser Permanente Full time**Job Summary**: Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utilization, Extended Care, Bed Placement, Discharge Planning, Transportation and...
-
Contract Specialist II
1 day ago
Fontana, United States Aalis Management Consulting Full timeJob DescriptionJob DescriptionAalis Management Consulting is an 8(a) certified, Service-Disabled Veteran-Owned Small Business (SDVOSB) and Economically Disadvantaged Woman-Owned Small Business (EDWOSB) driven by the same principles that guide our armed forces. Founded by a US Army veteran, we take pride in our core values: excellence in reputation,...
-
Contract Specialist II
39 minutes ago
Fontana, United States Aalis Management Consulting Full timeJob DescriptionJob DescriptionAalis Management Consulting is an 8(a) certified, Service-Disabled Veteran-Owned Small Business (SDVOSB) and Economically Disadvantaged Woman-Owned Small Business (EDWOSB) driven by the same principles that guide our armed forces. Founded by a US Army veteran, we take pride in our core values: excellence in reputation,...
-
Special Education Development Specialist
2 weeks ago
Fontana, United States Qualified Full timeEssential Duties and Responsibilities: - Develops and facilitates professional learning opportunities for special education service providers that promote achievement for all students in areas including curriculum, instruction, assessment, and classroom learning environment. - Collaborates with the Director of student services and peers to provide staff...
