Description

Description:

Job Summary:

Coordinates with physicians, staff, and non-Kaiser providers/facilities regarding patient care/ population based management for patients in specifically defined geriatric or other specifically defined patient populations in order to plan and implement a comprehensive, multi-disciplinary approach to manage health conditions, utilization of resources and protocols, patient self-care, implementation and evaluation of treatment plan across the care continuum (primary, secondary, tertiary and continued care). In conjunction with physicians, develops treatment plan, monitors care, makes recommendations for alternative levels of care, identifies cost-effective protocols and care paths and develops guidelines for care that may require coordination across systems of multiple providers/services. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.

Essential Responsibilities:

• Plans, develops, assesses and evaluates care provided to members.
• In conjunction with primary care and specialist physicians, evaluates and develops baseline medical and psychosocial evaluations and individualized patient care/treatment plans.
• Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
• Develops individualized patient/family education plan focused on self-management.
• Delivers patient/family education specific to a disease state.
• Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy).
• Coordinates care/services with utilization and/or quality reviewers 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/transfers as needed for outside services for patients/families.
• Makes referrals to appropriate community services and outside providers.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment, hospitalization or referral to support services or placement.
• Arranges and monitors follow-up appointments.
• Coordinates repatriation of patients and monitors their quality of care.
• Develops and collects data; trends utilization of health care resources.
• Produces population based reports on outcomes specific to defined patient populations.
• Participates with healthcare team/providers in actualizing outcomes by planning, evaluating and implementing decisions and strategies to achieve predetermined cost, clinical, quality, utilization and service outcomes.
• Develops and maintains case management policies and procedures.
• Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
• Acts as liaison for outside agencies, non-plan facilities, and outside providers.
• Participates in committees, teams or other work projects/duties as assigned.

Basic Qualifications:

Experience

• Minimum one (1) year clinical experience as an RN in an acute care setting, plus two (2)years clinical experience as an RN in a licensed home health or hospice agency required.

Education

• N/A

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 required.
• Computer literacy skills required.

Preferred Qualifications:

• Case Management Certification preferred.
• For positions in Special Needs & Care Programs (Care Plus/Guidance): Ambulatory Case Management experience preferred.
• Bachelors degree in nursing or healthcare related field preferred.

Primary Location: California,Anaheim,Orange Co Anaheim Medical Center
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri,
Working Hours Start: 08:30 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: B21|AFSCME|SCNSC
Job Level: Individual Contributor
Department: OC Anaheim Medical Center - Palliative Care - Other - 0801
Pay Range: $60.79 - $74.4 / hour Travel: No On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. 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.

Requisition #: 1408578

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