Case Management Outside Utilization RN
Company: Kaiser Permanente
Posted on: November 16, 2023
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
- 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
- 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
- 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
- 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
- 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
- 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.
License, Certification, Registration
- Registered Nurse License (California)
- Demonstrated ability to utilize/apply the general and
specialized principles, practices, techniques, and methods of
utilization review/management, discharge planning and case
- 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
- Computer literacy skills required.
- Bachelors degree in nursing or healthcare related field
- 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
Scheduled Weekly Hours: 36
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 -
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
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
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
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