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 is a repost of 182870
This position is a SCNSC bargaining unit represented position.
Basic Qualifications:
- Minimum two (2) 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.
Preferred Qualifications:
- Bachelor's degree in nursing or healthcare related field preferred.
- Bilingual (English/Spanish) Level II.
- Ability to work collaboratively with physicians and Health Care Team.
Notes:
- Start times may vary to cover evening hours.
- Rotating weekends minimally every 3rd weekend.
- Sunday shift will be in Riverside as MOB not open.
- Complex Chronic Disease Management to include, but not limited to Diabetes, High Cholesterol, HTN, COPD, Asthma, and CHF.
- Utilization of Clinical Practice Guidelines to titrate medications in partnership with PCP.
- Case Manager may cover all MOB's in Riverside Service Area, including future MOBs.
- Duties include: Appointment templates with the availability for walk-in support for MOB, Panel Management, Retinal Photos, Multiple projects/pilots.
- Weekend Responsibilities: Walk-in appointments, Hard to reach patient list, Retinal photos, additional focused outreach lists as directed by Regional Complete Care and Medical Center needs.
Primary Location: California-Wildomar
Scheduled Hours (1-40): 20
Shift: Day
Working Days: Mon, Tues, Wed, Thurs, Fri, Sat, Sun
Working Hours Start: 8:30 AM
Working Hours End: 5:00 PM
Schedule: Part-time
Job Type: Standard
Employee Status: Regular
Employee Group: Non-Union, Non-Exempt
Job Level: Individual Contributor
Job: Case Management
Public Department Name: Complete Care - Population Care Management
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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