DEPARTMENT: Continuing CareSCHEDULE: Full-Time Regular, 40 hours per week, Day shift. Monday through Friday: 8:00am to 5:00pm.EDUCATION: Bachelor�s degree, or equivalent experience, in nursing or health related field. Masters degree preferred. Graduate of an accredited school of nursing.LICENSE/CERTIFICATION: Current California RN license required. PHN preferred.JOB SUMMARY: Please be aware that this position is currently under review as part of the jurisdictional process with the California Nurses Association to determine whether such position should be assigned to the CNA bargaining unit. This review is on a position-by-position basis and includes an analysis of the actual duties performed in each position under review. This determination will be made within the next several months. Should the determination be made that the position does belong to the CNA bargaining unit, you will be offered the opportunity to (a) follow the work into the CNA bargaining unit and become a member of the union, or (b) seek other employment within the organization. Should you have any questions regarding this notice, please contact your recruiter for further information. Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care. In conjunction with physicians, develops treatment plan, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care.QUALIFICATIONS: Previous case management experience preferred. Demonstrated experience in utilization management, discharge planning, or transfer coordination. Knowledge of Nurse Practice Act, The Joint Commission and other federal/state/local regulations.PREFERRED QUALIFICATIONS: Current California Driver�s License and insurance. Current CPR certification required. PHN required. Must have effective interpersonal skills with members/family and multidisciplinary team. Previous case management experience preferred. Demonstrated experience in Utilization management and discharge planning. Knowledge of claims process preferred. Good working knowledge of community resources. Must have valid California driver�s license and operating vehicle and valid insurance coverage.SKILLS TESTING: N/ADUTIES: Plans, develops, assesses, and evaluates care provided to members. In conjunction with physicians, evaluates and develops treatment plans, recommends alternative levels of care, and ensures compliance with federal, state, and local requirements. Develops and maintains case management policies and procedures. Coordinates, directs, and performs concurrent and retrospective reviews, 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 as needed for outside services for patients/families. Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization. Arranges and monitors follow-up appointments. Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy). Makes referrals to appropriate community services. Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum. Develops and collects data, and trends utilization of health care resources. Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies. Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies. Acts as liaison for outside agencies, non-plan facilities, and outside providers. Coordinates repatriation of patients and monitors their quality of care. OTHER DUTIES:-This position will work out of an Oakland office and will visit patients in their home settings in the Oakland and Richmond, Berkeley areas. Will also see patients in the Oakland clinics and hospital.-Provide case management for the resource intensive members in the claims and KFH population. Develops plan of care across the continuum for the specific population. -Evaluates and develops care path, recommends alternate levels of care, and monitors level and quality of care for this population.-Coordinates the interdisciplinary approach to providing continuity of care, with emphasis on home setting and linkage to Kaiser and community resources.-Works with patients in the home setting, clinic and hospital. Helps transition patients and families through disease process, end of life issues working closely with Home health and Hospice programs.-Develops and collects data, trends utilization of health care resources, interprets regulations, health plan benefits, policies and procedures. Identifies and recommends opportunities for improving the quality of care and cost savings across the continuum.Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees. Consistently supports compliance and the Principles of Responsibility (KP�s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures. In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrated the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.PLEASE NOTE: - Kaiser Permanente is an AA/EEO employer -