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Case Manager RN, Util. Mgmt.-Victorville, Per-Diem Day - Fontana, United States - Kaiser Permanente
Description
Onsite at a KP contracted hospital in Victorville, CAJob 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.
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.
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.
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.
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, analyses 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.
Participates in committees, teams or other work projects/duties as assigned.
Basic Qualifications:
Experience
Two (2) years combined RN experience in an acute care setting or case management required.
Education
Completion of an accredited RN training program that allows graduates to take RN license exam.
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, discharge planning or case management.
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:
Bachelors degree in nursing or healthcare related field.
acute case management experience preferred.
Notes:
The case manager location will be at Saint Mary's Medical Center in Victorville
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