Inpatient Psych Case Mgr(Physical loc in Hayward/Union City)
This position supports Kaiser Permanente�s code of conduct and compliance by adhering to all lawsand regulations, accreditation and Licensure requirements, and internal policies and procedures.Kaiser Permanente is proud to be an equal opportunity/affirmative action employer.DEPARTMENT: IUS Psychiatric ReferralSCHEDULE: Full-time regular, 40 hours per week, Day shift, Monday through Friday: 8:30-5:00PM. Thecost center for this position is in the Diablo Service Area but the employee will be located inHayward/Union City (with training and meetings in Martinez).Position Summary: Provides inpatient and intensive outpatient case management for high-risk,high-utilizing members with acute and/or chronic psychiatric conditions across the continuum ofcare. Develops treatment and care plans for the specific population.Education/License/Certification: Master�s (Social Work or Psychology), or PhD (Psychology) required. LCSW, MFT or PsychologistLicense required. Must have a National Provider Identifier (NPI), or obtain an NPI, prior toemployment start date.Qualifications: Previous experience (usually 2 years) in an inpatient psychiatric setting or psychiatric emergencyservice.Previous experience (usually 2 years) of care management or clinical experience, and responsibilityfor a large caseload (50-100) for an extended period of time.Demonstrated expertise in crisis management.Demonstrated experience in utilization data collection and cost benefit analysis.Knowledge of JCAHO, and other local, state, and federal regulations.Must be able to work in a Labor Partnership Environment.Duties: Plans, develops, coordinates, assesses, and evaluates services provided to members topromote quality and cost effective outcomes. Develops and maintains case management policies andprocedures to assure optimal and appropriate member utilization of services. Coordinates theinterdisciplinary approach to providing continuity of care, including utilization management,transfer coordination, discharge planning, and obtaining all authorizations/approvals for outsideservices. Participates in the development of care paths. As an Intensive Case Manager coordinatesthe care of a large caseload of high risk patients and provides assessments and interventions in thecommunity including in-home visits. Consults with internal and external physicians, health careproviders, discharge planning and outside agencies regarding continued care/treatment orhospitalization. Arranges and monitors follow-up appointments. Makes referrals to appropriatecommunity services. Identifies and recommends opportunities for cost savings and quality of careimprovements across the continuum. Develops and collects reports and data, and trends utilization ofhealth care resources. Develops and presents in-service training and communication to both internaland external stakeholders Interprets regulations, health plan benefits, policies, and procedures formembers, physicians, medical office staff, contract providers, and outside agencies. Coordinates thetransmission of clinical and benefit information and treatment to patients, families and outsideagencies including issuing Non-Coverage and Denial of Benefits letters consistent with Health PlanRegulations. Acts as liaison to psychiatry clinics outside agencies, non-plan facilities, andoutside providers.Coordinates repatriation of patients and monitors their quality of care.Provides administrative case management oversight to Inpatient Psychiatric Facilities, CrisisResidentialPrograms, and IMDs to ensure that services delivered to our members meet Kaiser�s Quality andUtilization expectations and guidelines.Provides administrative on-call to the RSR/Subregional Office.Provides Clinical and Administrative documentation in accordance with Kaiser Regional PsychiatricStandards including the Inpatient/Integrated Urgent Services Guidelines.Travel is required.Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, KaiserPermanente reserves the right to reevaluate and change job descriptions, or to change such positionsfrom salaried to hourly pay status. Such changes are generally implemented only after notice isgiven to affected employees.Consistently supports compliance and the Principles of Responsibility (KP�s code of conduct) bymaintaining confidentiality, protecting the assets of the organization, acting with ethics andintegrity, reporting non-compliance, and adhering to applicable Federal and State laws andregulations, accreditation and licensure requirements, and KP policies and procedures.In addition to defined technical requirements, accountable for consistently demonstrating servicebehaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission aswell as specific departmental/organizational initiatives. Also accountable for consistentlydemonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior andculturally sensitive service to each other, to our members, and to purchasers, contracted providersand vendors.PLEASE NOTE: - Kaiser Permanente is an AA/EEO employer -