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The Patient Care Coordinator (PCC) is obligated to maintain and constantly evaluate the appropriateness of a member/patient level of care, to maintain the efficiency and integrity of the referral process, and to monitor the quality of outcomes.

Preferred Skills: Acute care hospital utilization review and discharge planning. Knowledge of Microsoft Word. PURPOSE: In general, the Patient Care Coordinator (PCC) is obligated to maintain and constantly evaluate the appropriateness of a member/patient level of care, to maintain the efficiency and integrity of the referral process, and to monitor the quality of outcomes. The critical skills needed to perform this job are: Ability to effectively communicate; ability to conform to established policies and procedures; ability to analytically; problem solve and make decisions; ability to tolerate and cope with ambiguity; and ability to work as a team member. This position also has compliance accountability and/or responsibility for Kaiser Permanente´s policies and procedures, the Principles of Responsibility, accreditation standards (if applicable),and applicable federal, state, and local laws and regulations, as well as, proper use of Kaiser Permanente Personal Computer (PC) and applications. Required Experience and Training: R.N. license in jurisdiction where assigned. B.S.N. preferred. CPR certification required. At least one-year experience in acute hospital utilization review or equivalent required. Recent acute care, case management, or home health experience preferred. Demonstrated ability to effectively and clearly present information through the written word; to influence or persuade others through oral presentation in positive or negative circumstances; to listen well. Demonstrated ability to write clearly, legibly and effectively; to present ideas and document activities; to read and interpret written information.

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.

The Ambulatory Care Manager reports to the Director of Care Management.

The Ambulatory Care Manager is responsible for facilitating and coordinating the care delivered to an assigned group of patients through multidisciplinary, multi-agency, and patient/family collaboration to ensure the delivery of cost effective quality care outcomes within various ambulatory care settings. This position focuses on Outpatient area, cardiac and surgery with some coverage responsibility for Emergency Trauma Center. Care management goals include patient advocacy; facilitate quality care and desired outcomes for patients; promote utilization of most appropriate level of care; obtain financial certification; decrease inappropriate clinical resource usage; promote early, timely discharge and provide smooth transition along continuum of care. Coordination involves assessment, planning, support, and evaluation of patient care and related outcomes. Activities to be performed include but are not limited to: utilization management, insurance verification, pre-certification with payors, clinical care management, clinical resource management, clinical teaching, and discharge planning. The Ambulatory Care Manager provides professional nursing care within Borgess Medical Center. The practice of professional nursing is the systematic application of specialized knowledge and skill, derived from the biological, physical, and behavioral sciences to the care, treatment, counsel and health teaching of individuals who are experiencing changes in normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury or disability and demonstrates this through the application of the Standards of Clinical Nursing Practice and Standards of Professional Performance defined by the American Nurses Association. The Ambulatory Care Manager recognizes that each patient is an unique individual and has the right to quality nursing care that ensures mutual goal setting between the Ambulatory Care Manager and the patient and that the Ambulatory Care Manager assures patient rights and privacy are protected. Recognizing personal, interpersonal, and social systems, the nursing process facilitates the promotion, maintenance and restoration of an individuals health, incorporating knowledge of growth and development through the life span. The Ambulatory Care Manager is held accountable to the ethical and professional standards as defined in the ANA Code for Nurses, the ANA Nursings Social Policy Statement, the State of Michigan Public Health Code, and the ANA and Specialty Nursing Standards of Clinical Practice. The Ambulatory Care Manager is held accountable to the standards set by BMC as defined in the Administrative, Patient Care and Biosafety Policy and Procedure Manuals. The Ambulatory Care Manager is also accountable to adhering to the standards set by regulatory agencies such as but not limited to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Conditions of Participation of Healthcare Finance Administration (HCFA), Michigan Occupational Health and Safety (MOSHA) and Emergency Medical Treatment and Active Labor Act (EMTALA). These accountabilities require individual competence in nursing practice, and the recognition and responsible acceptance of individual actions and judgments. Requirements:Bachelors degree in a health related field and 5 years recent experience/certification in utilization management, case management or focused discharge planning preferred. BSN or MSN or completion of BSN within 1 year of date of hire and one year experience certification in utilization management, case management or focused discharge planning preferred. Must be currently licensed as a registered nurse in the State of Michigan. Minimum of two years clinical experience in any setting. Prefer one year experience in an ambulatory care center specialty (acute healthcare environment) to assure sufficient understanding of patient types and to serve as expert resources to care teams. Other Requirements: Evaluation demonstrates past excellence in nursing practice and accountability in resolving patient care and system issues. Current knowledge and experience working with the following (for example): Community resources and services; placement options. Appropriate level of care (home care, rehab, and sub acute care, extended care facility). Rules and regulations of third party reimbursement for post hospital care/equipment. Current knowledge and experience working with third party payers regarding the following (for example): Appropriate criteria for hospitalization of patients. Pre-certification requirements. Requirements by payers for special review types. Basic computer skills in word processing and spreadsheet software preferred. Demonstrates leadership ability, communication, and interpersonal skills necessary to interact effectively with physicians, team members, external agencies/customers and patients/families. Analytical skills necessary to collect, tabulate, and analyze data to determine and implement effective actions and solutions. Work assigned/rotated shifts on weekends and holidays.

The Case Manager is responsible to assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning. Including but not limited to daily review of medical records to determine appropriateness and medical necessity of admission, continued hospital stay and use of ancillary services.Qualifications Licenses/Certifications:• LPN or Registered Nurse LicenseExperience/Skills:• Minimum of three years nursing experience required.• Excellent communication skills and ability to work collaboratively with all members of the health care team.• Prior experience in UR or Case Management preferred

RNs for Admissions and Case Management in Northern VA!

At VITAS, the nations leading hospice provider, established in 1978 and currently operating 43 programs in 15 states, youll be empowered to always put the needs of patients and their families first. Well support your efforts in every way possible and reward your commitment with competitive compensation, flexible schedules and comprehensive benefits, including tuition reimbursement, 401(k) with a match and a generous paid time off plan. As part of our interdisciplinary team, youll be the pivotal person who provides care, compassion and support to out patients and their families. We are seeking RN case managers and admissions nurses in Northern VA. Qualified candidates must be Virginia licensed RNs with two or more years of med/surg experience. Previous hospice, oncology, and/or homecare experience preferred. VITAS offers a comprehensive benefits package, including health/dental/vision, life insurance, 401(k) with company match, long and short term disability, tuition reimbursement, EAP, employee discounts and a generous paid time off plan. Visit our career site at www.vitas.com to read about our history, our growth, and the many ways in which weve made a difference!

The VITAS nurse is a member of the interdisciplinary team and is the pivotal person in identifying the physical, psychological, social and spiritual needs of the patient and family. Initiates appropriate intervention and support for the patient and family upon admission to VITAS and provides a continuously appropriate, comprehensive and responsive plan of care.QUALIFICATIONS: Currently licensed as a Registered Nurse. Minimum 2 years medical/surgical, with hospice or home health, experience preferred. Must have reliable transportation with appropriate insurance coverage.EDUCATION: Completion of course study as required to acquire state licensure.

Kingston Hospital Campus

Summary of Job Purpose: Coordinates care and service of selected patients across the health care continuum. Promotes effective utilization of resources and the highest quality of care for optimal clinical and resource outcomes. Ensures appropriate lengths of stay based on medical necessity. Assesses and implements effective discharge planning through identification of appropriate services and facilities across the continuum of care. Assumes a leadership and communication role with the patient/family, interdisciplinary team members, and providers if appropriate services across the continuum. Provides ongoing monitoring and evaluation of the plan across the continuum as appropriate.B. Essential Job Qualifications: Education: RN, Graduate of an accredited school of Nursing or BSW/CSW (BSW minimum) or Masters in another health related field. Preferred: RN with BSN or CSWExperience: 2 years hospital based. Knowledge of medical/surgical cases. One (l) year QA/UR or Case Management preferred. Current knowledge of Federal and State regulations.Training/License: PRI certification preferred.Other: Clinical competency; excellent verbal and written communication skills; strong organizational skills.

The Director of Case Management is responsible for the implementation of the Case Management and Resource Management Program. Including but not limited to daily review of medical records to determine appropriateness and medical necessity of admission, continued hospital stay and use of ancillary services.Qualifications Education:• Graduate of an accredited school of nursing.Certification / Licenses:• Current state Nurse license • Must possess an Associate degree in Nursing from an accredited School. Bachelor degree or Masters degree in Nursing required.Experience:• Minimum of three years nursing experience required. • Prior experience in UR or Case Management required. • Registered Nurse able to demonstrate excellent communication skills and ability to work collaboratively with all members of the health care team. • Requires physical stamina and emotional stability.

Valparaiso Hospital Campus

The Clinical Documentation Improvement Specialist is responsible for improving overall quality, specificity, and completeness of physician clinical documentation. develops and implements documentation improvement plans with HIM direction to ensure hospital case-mix index, severity of illness, and risk of mortality profiles are complete and properly documented by physicians.Qualifications Required1. Associate or Bachelor´s degree in Nursing from an accredited college or university. (Diploma required)2. Current Indiana Registered Nurse Licensure3. Completion of 15.0 CEU´s annually in the areas of Clinical Acute Care, Sub-Acute Care, Healthcare Reimbursement Systems or Management Preferred1. Prior experience as Clinical Documentation Improvement Specialist or Case Manager

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.