Case Management Outside Utilization RN

Company: Kaiser Permanente
Location: Downey
Posted on: November 16, 2023

Job Description:

Description: Coordinates continuing care/outside services for continuing care members at one medical center. Repatriate stable Kaiser Permanente members from non-Kaiser Permanente facilities in the emergency department and admitted patients. The process involves screening for appropriateness of care and talking to the outside physician to establish stability to transfer to a Kaiser Permanente facility. Works with KFH and SCPMG staff in developing service plans, providing quality care, cost effective services that are aligned with federal, state and local regulations and continuing care business goals/objectives. Complies with other duties asdescribed.

Essential Responsibilities:

• Coordinates the administration and delivery of assigned outside services at one medical center.
• Collaborates with physicians, service directors, and other health care providers to identify and implement innovative models and best practices, emphasizing service improvements and cost reduction.
• Develops and implements quality and utilization standards to ensure coordinated plans of treatment, customer focused delivery of services and cost effective utilization of necessary services.
• Ensures compliance with administrative, legal and regulatory requirements of the Health Plan contract and governmental regulatory and accrediting agencies.
• Develops and enhances unit based standards as identified by regulatory agencies.
• Provides services that meet standards for customer satisfaction with emphasis on customer service, quality and innovation.
• Acts as liaison with non-plan providers.
• Develops and expands relationships with contractors/providers.
• Utilizes research data to implement service changes and improve the delivery of patient care and member outside services.
• Identifies and recommends opportunities for cost savings and improving the quality of care and service.
• Participates in committees, teams or other work projects/duties as assigned.
  Basic Qualifications:
  
  Experience
  
  
  • Minimum two (2) years clinical experience as an RN in Critical Care or case management required.
  • For positions in KP Reconnect & Transitional Care Case Management Program only (substitute first sentence above): Minimum two years clinical experience as an RN in Acute Care or case management required.
  • For positions in Centralized Behavioral Health Care (Psych) Utilization Mgmt: (substitute first sentence above): Minimum two years clinical experience as an RN in Acute Care Psych or psych case management required.
    
    Education
    
    
    • N/A
      
      License, Certification, Registration
      
      
      • Registered Nurse License (California)
        
        Additional Requirements:
        
        
        • Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques, and methods of utilization review/management, discharge planning and 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.
        • Computer literacy skills required.
          
          Preferred Qualifications:
          
          
          • Bachelors degree in nursing or healthcare related field preferred.
            
            Notes:
            
            
            • Every other weekend
            • If twelve (12) hour option chosen, shift will be 9:00 am-9:30 pm, back up 8 hour shift will be 9:00 am to 5:00 pm.
              
              Primary Location: California,Downey,Downey Boeing - Independence Park
              Scheduled Weekly Hours: 36
              Shift: Day
              Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
              Working Hours Start: 09:00 AM
              Working Hours End: 09:30 PM
              Job Schedule: Full-time
              Job Type: Standard
              Employee Status: Regular
              Employee Group/Union Affiliation: B21-AFSCME-SCNSC
              Job Level: Individual Contributor
              Department: Independence Park - Centralized O/S Utility Mgmt - 0806
              Pay Range: $58.43 - $71.51 / hour The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
              Travel: No At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
              
              Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest

Keywords: Kaiser Permanente, Downey , Case Management Outside Utilization RN, Healthcare , Downey, California