Qualifications: 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. PHN preferred. 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. Consistently demonstrates the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to customers, contracted providers, and vendors.
Preferred Qualifications: Bilingual (English/Spanish). BLS. Surgical and Robotic experience. Urology experience. Excellent communication skills. Ability to work as part of a team as well as independently. Excellent customer service skills and work ethic.
Duties: 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. 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. 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. Kaiser Permanente is an EEO/AA Employer.