Case Mgr RN

Health care is changing. Kaiser Permanente leads the way. More than eight million people rely on us for their healthcare. Join our outstanding team and make a difference...every day. Our quality of care is unmatched and so are our health care careers. Employment opportunities are available throughout our California Region, made up of 28 acute care hospitals, including two specialty tertiary centers and 120 ambulatory care centers. Our 85,000 employees and more than 7,000 physicians provide the highest quality of care to over 6 million members. Come join our award winning team and enhance your skills in a full time, part time or per diem position.Qualifications: Bachelors degree, or equivalent experience, in nursing or health related field. Masters degree preferred. Graduate of an accredited school of nursing. Current California RN license required. PHN preferred.  Previous case management experience preferred. Demonstrated experience in utilization management, discharge planning, or transfer coordination. Knowledge of Nurse Practice Act, The Joint Commission and other federal/state/local regulations. Preferred Qualifications: Experience working with patients in an ambulatory care setting addressing depression and cardiovascular disease. Familiarity with Health Connect as it relates to patient care and management. Excellent communication and written skills. Able to problem solve efficiently, flexible and willing to learn new tasks, hard-working, and a team player. Work ethics reflect our KP Values and goals. Meets expected productivity and outcome measures. Computer Skills: Health Connect, KPDS/OPAS, POINT, Amcare, and Microsoft Excel/Word/Powerpoint.Duties: Plans, develops, assesses, and evaluates care provided to members. In conjunction with physicians, evaluates and develops treatment plans, recommends alternative levels of care, and ensures compliance with federal, state, and local requirements. Develops and maintains case management policies and procedures. Coordinates, directs, and performs concurrent and retrospective reviews, and monitors level and quality of care. 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. Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization. Arranges and monitors follow up appointments. Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy). Makes referrals to appropriate community services. Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum. Develops and collects data, and trends utilization of health care resources. Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies. Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies. Acts as liaison for outside agencies, non plan facilities, and outside providers. Coordinates repatriation of patients and monitors their quality of care. Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures.Notes: When coverage of CSG Chart Review “pre-reviewâ€� (review of Health Connect documentation & no direct patient interaction) is needed, this job can be done remotely with pre-authorization by management. The employee must meet a minimum number of charts reviewed per hour as determined by management. The RN will also need to come to the medical center for staff and pertinent meetings as needed. If patient interaction is required (depression, HF, CSG chart review compliance calls), the RN will be required to come to the medical center to complete work. Days and hours may vary according to deparmental needs, contingent on volume of CSG chart reviews needed. Flexibile schedule so long as reviews completed by specified date/time. We are an EEO/AA/M/F/D/V Employer. Additional Information Reference Code: 1013390 Position Type: Part Time