Case Management Utilization RN
Company: Kaiser
Location: Pomona
Posted on: March 20, 2023
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Job Description:
Sign-On Bonus eligible position: $4,000
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 and acceptable discharge plan.
Functions as an indirect caregiver, patient advocate and manages
patients in the most cost effective way without compromising
quality. Transfers stable non-members to planned Health care
facilities. Responsible for complying with AB 1203, Post
Stabilization notification. Complies with other duties as
described. Must be able to work collaboratively with the
Multidisciplinary team, multitask and in a fast pace
environment.
Essential Functions:
--- Plans, develops, assesses & evaluates care provided to
members.
--- Collaborates with physicians, other members of the
multidisciplinary health care team & patient/family in the
development, implementation & documentation of appropriate,
individualized plans of care to ensure continuity, quality &
appropriate resource use.
--- Recommends alternative levels of care & ensures compliance with
federal, state & local requirements.
--- Assesses high risk patients in need of post-hospital care
planning.
--- Develops & coordinates the implementation of a discharge plan
to meet patient's identified needs.
--- Communicates the plan to physicians, patient,
family/caregivers, staff & appropriate community agencies.
--- Reviews, monitors, evaluates & coordinates the patient's
hospital stay to assure that all appropriate & essential services
are delivered timely & efficiently.
--- Participates in the Bed Huddles & carries out recommendations
congruent with the patient's needs.
--- Coordinates the interdisciplinary approach to providing
continuity of care, including Utilization management, Transfer
coordination, Discharge planning, & 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 & non-KFH facilities.
--- Acts as a liaison between in-patient facility & referral
facilities/agencies & provides case management to patients
referred.
--- Refers patients to community resources to meet post hospital
needs.
--- Coordinates transfer of patients to appropriate facilities;
maintains & provides required documentation.
--- Adheres to internal & external regulatory & accreditation
requirements & compliance guidelines
including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA &
DOL.
--- Educates members of the healthcare team concerning their roles
& responsibilities in the discharge
planning process & appropriate use of resources.
--- Provides patients with education to assist with their discharge
& help them cope with psychological
problems related to acute & 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, analyses & identifies utilization patterns & trends,
problems or inappropriate utilization of resources & participates
in the collection & analysis of data for special studies, projects,
planning, or for routine utilization monitoring activities.
--- Coordinates, participates & or facilitates care planning rounds
& patient family conferences as needed.
--- Participates in committees, teams or other work projects/duties
as assigned.
Basic Qualifications:
Experience
--- Two (2) years clinical experience as an RN in an acute care
setting required.
Education
--- Completion of an accredited RN training program that allows
graduates to take RN license exam.
Licenses, Certifications, Registrations
--- Current California RN license required.
--- AHA BLS.
Additional Requirements:
--- Demonstrated ability to utilize/apply the general and
specialized principles, practices, techniques and methods of
Utilization review/management, 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.
--- Demonstrated ability in planning, organizing, conflict
resolution and negotiating skills.
--- Computer literacy skills required.
Preferred Qualifications:
Notes:
Job Schedule:
Job Category: Nursing Licensed & Nurse Practitioners
Keywords: Kaiser, Pomona , Case Management Utilization RN, Executive , Pomona, California
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