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Seeking a Patient Care Coordinator!

Department: Patient Care Services Coordination of CareSchedule: On-call, Regular, 00 hours per week, 07:30 - 16:00 (May include weekends, evenings and after hours. Based On Departmental Needs.)Position 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 plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care. Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the health care team.Education/License/Certification: Bachelors degree, or equivalent experience, in nursing or health related field. Masters degree preferred. Graduate of an accredited school of nursing. Current California RN license required.PREFERRED Education/License/Certification: BSN or BA in health care related field or Diploma/Associate Degree Nursing (ADN) with comparable years of experience required. Masters Degree preferred. Graduate of accredited school of nursing. Current California RN licensure required, BLS Certification 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: Experience (usually 2+ years) in direct patient care delivery or and management. Demonstrated experience in utilization review, case management, and discharge planning preferred (usually 2+years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA and all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgment abilities. Fundamental word processing and computer navigation skills and the ability to interpret and use analytic data in day to day operations. Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).Duties: Plans, develops, assesses, and evaluates care provided to members. In conjunction with physicians, evaluates and develops discharge plans, recommends alternative levels of care, and ensure 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 physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization. Encourages members to follow plans 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.OTHER Duties: Utilization Management Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately. Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives. Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care). Discharge Planning Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies. Performance Improvement Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols. Participates in the development and implementation of guidelines, preprinted physician orders, care paths, etc. For patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-daystays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Workplan initiatives. Administrative and Regulatory Shares accountability with the UM Manager for planning, developing, and managing the department budget. Participates in interviewing, makes hiring recommendations, orients and provides on-going supervision of support staff. Provides input into the performance evaluations of team members. May plan and control work assignments and special projects of team members. Assists in developing, implementing and maintaining utilization management policies and procedures. Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements (see qualifications). 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 licenser requirements (if applicable), and Kaiser Permanente�s policies and procedures.

This position supports Kaiser Permanente´s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures.Kaiser Permanente is proud to be an equal opportunity/affirmative action employer.DEPARTMENT: Continuing CareSCHEDULE: On-call, 00 hrs/week, Day shift, Sunday - Saturday, 8:00am to 5:00pm.EDUCATION/LICENSE/CERTIFICATION: BSN or BA in health care related field or Diploma/Associate Degree Nursing (ADN) with comparable years of experience required. Masters Degree preferred. Graduate of accredited school of nursing, BLS Certification, and current California RN licensure required.JOB SUMMARY: Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the healthcare team.QUALIFICATIONS: Experience (usually 2+ years) in direct patient care delivery and management.Demonstrated experience in utilization review, case management, and discharge planning preferred(usually 2+ years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA,HIPPA, ERISA, EMTALA and all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgment abilities. Fundamental word processing and computer navigation skills, and the ability to interpret and use analytic data in day to day operations. Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).DUTIES: Utilization Management: Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately.Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives.Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care).Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing , social services, and other healthcare providers and agencies.Performance Improvement: Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols.Participates in the development and implementation of guidelines, preprinted physician orders, care paths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-day stays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Work plan initiatives.PLEASE NOTE: - Kaiser Permanente is an AA/EEO employer -

This position supports Kaiser Permanente´s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures.

This position supports Kaiser Permanente´s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures. Kaiser Permanente is proud to be an equal opportunity/affirmative action employer. DEPARTMENT: Continuity of Care/Multi-Site (Modesto/Stockton) SCHEDULE: Full-Time Regular, 36-40hrs/wk, Night shift. Shift and locations may vary depending on need, 7:00pm to 7:00am. This is a multi-site position. Will work in Modesto and the Stockton facility. EDUCATION/ LICENSE/CERTIFICATION: BSN or BA in health care related field or Diploma/Associate Degree Nursing (ADN) or comparable years of experience required. Masters Degree preferred. Graduate of accredited school of nursing, BLS Certification, and current California RN licensure required. SKILLS TESTING: N/A QUALIFICATIONS: Experience (usually 2+ years) in direct patient care delivery and management. Demonstrated experience in utilization review, case management, and discharge planning preferred (usually 2+ years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA and all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgement abilities. Fundamental word processing and computer navigation skills, and the ability to interpret and use analytic data in day to day operations. Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.). POSITION SUMMARY: Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the health care team. DUTIES: Utilization Management Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately. Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives. Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care). Discharge Planning Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing , social services, and other healthcare providers and agencies. Performance Improvement Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols. Participates in the development and implementation of guidelines, preprinted physician orders, carepaths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-day stays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Workplan initiatives. Administrative and Regulatory Shares accountability with the UM Manager for planning, developing, and managing the department budget. Participates in interviewing, makes hiring recommendations, orients and provides on-going supervision of support staff. Provides input into the performance evaluations of team members. May plan and control work assignments and special projects of team members. Assists in developing, implementing and maintaining utilization management policies and procedures. Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements (see qualifications). 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 demonstrating 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.

Spectrum Healthcare Resources has an opportunity for a permanent, civilian RN Discharge Planner at Wilford Hall Medical Center at Lackland AFB in San Antonio, TXDetails:* Monday-Friday 7:30-4:30 p.m. * Excellent Compensation and Benefits * Up to 3 Weeks Paid Time Off * 10 Paid Holidays * Supportive Team Environment Requirements:* 6 yrs broad based nursing experience * Current, unrestricted RN license in state of TX * BLS required Company Overview: Established in 1988, Spectrum Healthcare Resources (SHR) has earned a solid reputation in the health care industry.  SHR is JCAHO certified and dedicates itself exclusively to supplying a broad spectrum of medical professionals, LPNs, CNAs, Registered Nurses, Nurse Practitioners, Physician Assistants and Physicians, for Military Treatment Facilities (MTF) located in the United States.  These permanent civilian contracted medical professionals experience a unique medical environment, working among the very best medical professionals, and caring for our military family.

Patient Care Coordinator/Case Mgr Opportunity!

This position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures.Kaiser Permanente is proud to be an equal opportunity/affirmative action employer.DEPARTMENT: Utilization ManagementSCHEDULE: Part-time regular, 24 hours per week, Day shift, Monday through Wednesday: 8:30-5:00.Schedule dependant upon departmental needs. Requires weekend rotation every other weekend, 48 hours per pay period.Position Summary: Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the health care team.Education/License/Certification: BSN or BA in health care related field or Diploma/Associate Degree Nursing (ADN) with comparable years of experience required. Masters Degree preferred. Graduate of accredited school of nursing, BLS Certification, and current California RN licensure required.Qualifications: Experience (usually 2+ years) in direct patient care delivery and management.Demonstrated experience in utilization review, case management, and discharge planning preferred(usually 2+ years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA,HIPPA, ERISA, EMTALA and all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgement abilities. Fundamental word processing and computer navigation skills, and the ability to interpret and use analytic data in day to day operations. Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).Duties: Utilization Management : Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately. Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives.Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care).Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing , social services, and other healthcare providers and agencies.Performance Improvement: Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols.Participates in the development and implementation of guidelines, preprinted physician orders, care paths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-day stays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Work plan initiatives.Administrative and Regulatory: Shares accountability with the UM Manager for planning, developing, and managing the department budget. Participates in interviewing, makes hiring recommendations, orients and provides on-going supervision of support staff. Provides input into the performance evaluations of team members. May plan and control work assignments and special projects of team members. Assists in developing, implementing and maintaining utilization management policies and procedures. Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements (see qualifications).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 demonstrating 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 -

Since 1925, Sarasota Memorial Health Care System has grown to become the second largest acute care public hospital in Florida. Our 806-bed regional medical center is consistently recognized for our centers of excellence, patient safety as well as our employee satisfaction. As our community has grown, we have remained committed to investing in the latest technology and services. Currently, we are seeking an experiencedClinical Case Manager II12 hour Shifts: 11am-11pmThroughout our community, we have built a reputation for excellent patient care and a supportive team environment. To ensure the continuation of this tradition, we are currently seeking an experienced Clinical Case Manager II for our 20 bed medical observation unit. As a vital part of the patient care team, the Clinical CM must be comfortable and assertive dealing with physicians, nurse practitioners and staff members at all levels while fostering a solid team atmosphere. This position requires extremely strong clinical knowledge and the ability to interact and present the various options and plans to patients and their families.In this role, the Clinical Case Manager Level II (Clinical CM II) will utilize their professional nursing skills to assess patient and family scenarios for clinical appropriateness for the setting and establish plans for effective management of the continuum of care (episodic and population-based) with an overall observation LOS goal of 18 hours or less. The candidate will also be required to precept new staff and peers in effective application of Milliman USA and Interqual guidelines, develop department and organization-wide program to address issues relating to managing and improving the quality of care, utilization, cost and patient satisfaction. JOB QUALIFICATIONS:1. Graduate of an accredited school of nursing with a current Florida license.2. Masters degree preferred, Bachelors Degree required. Diploma or Associates Degree in Nursing and Case management Certification (CCM, ACM, CPHQ, ABQUAURP) required or BSN or Bachelors degree in health care administration or relevant health care area of study. The director must approve any variation in these requirements.3. Minimum of five (5) years of clinical practice in acute care hospital.4. Strong MedSurg background required (Cardiac experience preferred) 5.At least one year of Utilization Review, Interqual and Milliman and/or Case Management experience required.6. One year experience in SMH ICM as level I Case Manager prior to applying to Level II position, as full time employee. 7. Basic experience using PC (computer) required (word processing minimum); Use of Internet preferred, including e-mail and calendar; previous experience with hospital information systems (order entry, results reporting) preferred.8. Must meet all standards on Level I CM job description and exceed in selected standards. See level II application.* These may be waived for external candidates with comparable experience and skills.Located just minutes south of the Tampa Bay area, SMH is ideally situated on Florida´s west coast minutes from beautiful white, sandy gulf beaches. With an abundance of sunshine and outdoor activities, our location offers an array of activities for all lifestyles. From our affordable housing, close proximity to theme parks, golf courses, top universities and schools, world-class cultural activities, you will soon discover the attraction to Sarasota and our state-of-the-art magnet hospital!We encourage you to learn more about our facility, awards and opportunities or apply for the above position by visiting us online at www.smh.com

MountainView Hospital

Part of Sunrise Health, MountainView Hospital is a full-service modern 250-bed facility in the heart of northwest Las Vegas. Here we offer a family-like culture and stress a team-based approach, aimed at continuing to achieve high levels of patient satisfaction. We are known for our low nurse-to-patient ratio and specialty adult and pediatric intensive care units, and were honored with a Service Excellence Award for women’s health and maternity care. We currently have an opportunity for a full-time Registered Nurse Case Manager to join our team. The Case Manager will work in conjunction with nurses, physicians, ancillary hospital departments, patients and families to identify and coordinate post-hospital needs of all patients, infant through geriatrics, in order to promote quality, continuity of care and safety for the patient. The Case Manager will carry out physician orders regarding transfers, home health care, durable medical equipment and the specific discharge needs of the patient, placing patients in the most appropriate setting upon discharge. In addition, he/she will monitor utilization of resources, track any avoidable days identified, respond to insurance requests for clinical reviews utilizing Interqual criteria and follow review protocols for the department.Qualified candidates must have:-Graduate degree from an accrediting nursing program-Associates or Bachelors Degree in Nursing preferred-Candidates with a Bachelors or Masters Degree in Social Work will be considered -Nevada Registered Nurse License -Basic Cardiac Life Support Certification or obtained within three months of hire-Case Management Certification preferred-A minimum of one year case management experience in an acute care facility or two years minimum experience in a managed care environment or rehab facility-Strong written and verbal communications skills-Strong computer skills and knowledge of Interqual criteriaAt Sunrise Health were guided by a simple yet powerful motto, Another Sunrise. Another Miracle.. And while technology is at the forefront of everything we do, we haven’t forgotten that its our people who make miracles happen and help our patients heal. As part of our team, we provide you with a benefits package designed to meet your individual needs.Whether you’re new to the area or a longtime resident, there’s always something new to discover in Las Vegas.

Hours: 7:30am - 4pm Days: Monday - FridayShift Type: DayWeekends: As Needed Job Description: Cedars-Sinai Medical Center, a 977-bed, Level I Trauma Center located near Beverly Hills, has exceptional case management opportunities available. Within our world-class teaching facility, you will make a significant contribution to the kind of nursing care that has repeatedly garnered us Magnet designation.Wee seeking dynamic individuals who would like to use their strong bedside background to play an even more active role in successful patient outcomes. Partnering with Masters-prepared Clinical Social Workers, you will assess patient cases in order to facilitate and drive the progression of their care.These positions require current CA RN licensure and recent clinical experience in inpatient acute care and case management. You must be passionate about patient involvement and motivated by leading an interdisciplinary care team. Case management certification is desired. Education and Work Experience Preferences: CA RN license required. Recent clinical experience, Inpatient Acute Care, Case Management and certification in case management preferred. Computer skills, excellent verbal, written communication skills required. Knowledge of medical literature, research methodology, health care delivery systems and financial reimbursement.Physical Demands:able to walk, stand for long periods of time.

Client Services has an immediate opening for a Registered Nurse with case management, intake, telephonic triage or comparable experience.

RN, Referral Intake Specialist/Intake NurseClient Services has an immediate opening for a Registered Nurse with case management, intake, telephonic triage or comparable experience. The Client Services Referral Specialist/Intake Nurse is an integral member of the team and functions to serve as a single entry/easy access point serving to minimize barriers to health care through service coordination to include, handling all phases of the intake referral process, and facilitating tertiary referrals from inception to completion.CA RN license required. A minimum of two years experience working/interacting with HMOs, PPOs, health systems or third party risk sharers in the Southern California healthcare market is essential. Prior experience in Utilization Review, Case Management or Intake and exceptional customer service skills are a must.

This position supports Kaiser Permanente´s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures. Kaiser Permanente is proud to be an equal opportunity/affirmative action employer. DEPARTMENT: Continuity of Care/Multi-Site (Modesto/Stockton) SCHEDULE: Full-Time Regular, 36-40hrs/wk, Night shift. Shift and locations may vary depending on need, 7:00pm to 7:00am. This is a multi-site position. Will work in Modesto and Stockon facilities. EDUCATION/ LICENSE/CERTIFICATION: BSN highly preferred or BA in health care related field. Diploma/Associate Degree Nursing (ADN) with comparable years of experience required. Masters Degree preferred. Graduate of accredited school of nursing, BLS Certification, and current California RN licensure required. SKILLS TESTING: N/A QUALIFICATIONS: Experience (usually 2+ years) in direct patient care delivery and management. Demonstrated experience in utilization review, case management, and discharge planning preferred (usually 2+ years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA and all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgement abilities. Fundamental word processing and computer navigation skills, and the ability to interpret and use analytic data in day to day operations. Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.). POSITION SUMMARY: Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the health care team. DUTIES: Utilization Management Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately. Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives. Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care). Discharge Planning Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing , social services, and other healthcare providers and agencies. Performance Improvement Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols. Participates in the development and implementation of guidelines, preprinted physician orders, carepaths, etc. for patient care. Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-day stays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Workplan initiatives. Administrative and Regulatory Shares accountability with the UM Manager for planning, developing, and managing the department budget. Participates in interviewing, makes hiring recommendations, orients and provides on-going supervision of support staff. Provides input into the performance evaluations of team members. May plan and control work assignments and special projects of team members. Assists in developing, implementing and maintaining utilization management policies and procedures. Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements (see qualifications). 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 demonstrating 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.