Description |
Working for an organization with the size and resources of Kaiser Permanente Southern California means having the potential to positively affect the health and well-being of entire communities. That's because each of us-from our financial professionals and IT team members to our RNs and physicians on the front line of care-shares a commitment to providing the best possible care experience. One of the most diverse regions in the country, Southern California offers everything from quaint coastal communities to bustling urban cities, high desert plains to snowy mountain peaks. Here, you'll find the cultural, lifestyle, and recreational amenities to complement your work and your life. Come discover the resources, support, and opportunity you need to build the career you've always wanted.
Works collaboratively with an assigned panel of physicians to manage the patient's specialized needs. The managing team does differ according to the chronic disease. Duties include assessment to identify member needs and development of specific care management plan to address needs. In conjunction with the physician, implements care/treatment plan by coordinating access to health services across multiple providers/disciplines, monitors care, makes determination to arrange transportation and transfer patient if indicated, identifies cost-effective measures, makes recommendations for alternative levels of care and utilization of resources, promotes self-care management, and ensures paper work is completed. Is an indirect caregiver. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.
Essential Functions:
- Evaluates and identifies members' needs.
- Interfaces with primary care physicians, specialists, and various disciplines on the development of case management plans/programs.
- Monitors and evaluates the effectiveness of the case management plans and modifies as necessary.
- 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.
- Acts as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers' compensation carriers, and third party administrators.
- Prepares reports, communicates program changes to appropriate staff, and develops protocols in accordance with state regulations.
- Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care.
- Develops individualized patient/family education plan focused on self-management; delivers patient/family education specific to a disease state.
- Develops and updates training and educational materials and presents to appropriate staff, members and families.
- Facilitates patients' return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
- Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
- May need to facilitate transportation and housing arrangements for patient.
- Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
- Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards.
- Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service.
- Ensures that accurate records are maintained of the care associated with each patient.
- Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
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Requirements |
This position is a SCNSC bargaining unit represented position
Basic Qualifications:
- Minimum two years clinical experience as an RN in an acute care or ambulatory care setting required.
- Bachelor's degree or equivalent experience (4 years) required.
- Current California RN license required.
- Current BLS.
- Case Management Certification or certification in the area of specialty preferred.
- Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of utilization review/management, care coordination, transfer coordination, 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.
Ability to manage annual Synagis Clinic for at-risk population. Previous case management experience preferred (usually two years chronic disease case management).Bachelor's degree in nursing or related field required. Masters degree and PHN preferred. Meet requirements to be a CCS paneled provider.
Preferred Qualifications:
- Bachelor's degree in nursing or healthcare related field preferred.
- This is a multi-department position in Pain Management and Physical Medicine & Rehabilitation.
- In support of the Integrated Pain Management care model, responsibilities will include:
- In-basket message management support for IPM physicians, Tapestry and external referral management, rehabilitation case management, oversight of the chronic pain population, and collaborative case management with Primary Care and other Specialty departments.
- Participation as a member of a multi-disciplinary Integrated Pain Management (IPM) team will require addressing the needs and managing the care of patients with chronic pain and various musculoskeletal, neuro-orthopedic conditions.
- Must have excellent customer service skills and be able to work collaboratively with Primary Care and Specialty departments.
Notes:
- Will require travel to various PNM and PM&R department locations as well as any future sites to be determined, for regular work, night clinics, staff meetings, training or other assigned duties.
Primary Location: California-San Diego
Scheduled Hours (1-40): 40
Shift: Variable
Working Days: Mon, Tues, Wed, Thurs, Fri, Sat, Sun,
Working Hours Start: Varies
Working Hours End: Varies
Schedule: Full-time
Job Type: Standard
Employee Status: Regular
Employee Group: Non-Union, Non-Exempt
Job Level: Individual Contributor
Job: Nursing Licensed
Public Department Name: Pain Managment/Physical Medicine
Travel: No
Job Eligible for Benefits: Yes
External hires must pass a background check/drug screen. We are proud to be an equal opportunity/affirmative action employer.
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