Case Manager Utilization RN- Per Diem Day, Onsite Victorville

Job 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. Interacts with the family, patient and other disciplines to coordinate a safe and acceptable discharge plan. Functions as an indirect caregiver, patient advocate and manages patients in the most cost effective way without compromising quality. Transfers stable non-members to planned Health care facilities. Responsible for complying with AB 1203, Post Stabilization notification. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team, multitask and in a fast pace environment.

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.

• Recommends alternative levels of care and ensures compliance with federal, state and local requirements.

• 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.

• Participates in the Bed Huddles and carries out recommendations congruent with the patients needs.

• 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.

• Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.

• 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.

• Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed.

• 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.

• 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.

• Demonstrated ability in planning, organizing, conflict resolution and negotiating skills.

• Computer literacy skills required.

Preferred Qualifications:

• Bachelors degree in nursing or healthcare related field.

• BSN and acute case management experience preferred.

Notes:

• The case manager location will be at Saint Mary's Medical Center in Victorville.

COMPANY: KAISER

TITLE: Case Manager Utilization RN- Per Diem Day, Onsite Victorville

LOCATION: Fontana, California

REQNUMBER: 1284807

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

Kaiser Permanente Culture:

Located in the dynamic community of Laguna Hills, CA, Kaiser Permanente is a beacon in the healthcare industry, offering diverse job opportunities for those dedicated to making a difference in healthcare services. As a premier healthcare provider, we are dedicated to excellence and innovation across various healthcare sectors, positioning us as a top choice for professionals seeking healthcare jobs near Laguna Hills, CA. Our mission is to deliver unparalleled healthcare services to our community, a commitment that is at the core of our culture and motivates our ongoing search for passionate individuals to join our team.

Kaiser Permanente has become a key player in the Laguna Hills, CA healthcare landscape, not only by providing exceptional care but also by generating extensive employment opportunities for healthcare professionals. Whether you are a seasoned Case Manager Utilization RN- Per Diem Day, Onsite Victorville or a recent graduate ready to embark on your healthcare career, Kaiser Permanente offers a supportive and dynamic environment where your talents are valued and your professional development is encouraged. With our broad operations in Laguna Hills, CA, we are continually seeking skilled individuals to fill roles in various categories, ensuring a steady demand for healthcare professionals in our community.

Kaiser Permanente is at the forefront of addressing the growing need for quality healthcare in Laguna Hills, CA, offering numerous job openings for those searching for healthcare positions in their vicinity. Our dedication to adopting the latest healthcare technologies and methodologies means our team is ever-expanding, with a keen interest in hiring professionals such as (RN) Case Managers for Assisted Living, Associate Dentists, Clinical Pharmacists, Field Training Audiologists, Occupational Therapists, Social Workers, and Staff Physical Therapists, who are eager to positively impact our patients' lives. Joining Kaiser Permanente places you among a group of dedicated professionals committed to delivering the best healthcare in Laguna Hills, CA, and beyond.

For individuals in Laguna Hills, CA seeking healthcare jobs near them, Kaiser Permanente offers a unique chance to work in a cutting-edge facility that prioritizes both the professional growth of its staff and the health of its patients. We recognize the significance of local employment opportunities in building a strong community and proudly provide a variety of positions that accommodate the diverse expertise within the healthcare field. From clinical roles like (RN) Case Managers, Associate Dentists, and Clinical Pharmacists to specialized positions such as Field Training Audiologists, Occupational Therapists, Social Workers, and Staff Physical Therapists, Kaiser Permanente is eager to attract and retain top talent in and around Laguna Hills, CA.

In conclusion, Kaiser Permanente is more than a leader in healthcare; we are a significant employer in the healthcare sector within Laguna Hills, CA. Our dedication to excellence in healthcare services is paralleled by our commitment to creating job opportunities for those seeking healthcare positions close to home. By choosing to grow your career with Kaiser Permanente, you're not just joining a team of exceptional healthcare professionals; you're also contributing to the well-being of the Laguna Hills, CA community. We invite you to explore the exciting career opportunities at Kaiser Permanente and take the first step toward a rewarding healthcare career, right here in Laguna Hills, CA.

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