Case Manager OS Utilization RN

Job Summary

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 as described.

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

• Please refer to Minimum Work Experience and Qualifications Sections.

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.

PrimaryLocation : California,Bakersfield,Discovery Plaza Medical Offices

HoursPerWeek : 40

Shift : Day

Workdays : Mon, Tue, Wed, Thu, Fri

WorkingHoursStart : 08:00 AM

WorkingHoursEnd : 05:00 PM

Job Schedule : Full-time

Job Type : Standard

Employee Status : Regular

Employee Group/Union Affiliation : B21|AFSCME|SCNSC

Job Level : Individual Contributor

Job Category : Nursing Licensed & Nurse Practitioners

Department : Discovery Plaza MOB - Medical Office Admin Services - 0806

Travel : Yes, 10 % of the Time

Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:

• 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 licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.

• Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.

• Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.