Coordinator Patient Care - Case Management
Primary Location Honolulu, Hawaii
Worker Location Onsite
Job Number 1317734 Date posted 11/04/2024
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Description:
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.
Job Summary:
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.
Essential Responsibilities:
- The primary job duties this position is responsible for achieving are listed in order of importance.
- Performs daily pre-admission, admission, and concurrent utilization reviews to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved immediately. Performs rounds and reviews patient admissions under Kaiser Skilled Nursing Facility (SNF) benefit. Utilizes knowledge and experience of Medicare regulations and Health Plan benefits to determine medical necessity. Monitors the progression of the plan of care and facilitates discussions with the multidisciplinary 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. Issues denial/notices of non-coverage letters after conferring with physicians.
- Ensures continuity of care for outside services for the patient. Monitors level of care. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies.
- Monitors care processes and participates in the development and implementation of guidelines, pre- printed 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. Establishes and maintains effective relationships between Kaiser Permanente and the community facilities. Identifies quality improvement and relationship building opportunities. Monitors high-cost cases and reports findings to Hospital Administration, Director of Continuing Care and/or Community Medical Services. Keeps abreast of current changes in health care benefits, laws or regulatory requirements which influence health plan benefit issues.
- May perform patient care to the extent necessary to maintain clinical expertise, competency, and licensing necessary to fulfill job responsibilities and to direct the provision of care on the unit.
- Provides direct patient care on an as needed basis. Provides services that are within scope of license and in compliance with all legal, regulatory, and policy requirements relevant to clinical role performed.
- Incorporates the KP Nursing Vision, Model and Values throughout their Nursing Practice.
- Minimum two (2) years of experience in utilization review, case management, transitional care, and discharge planning OR two (2) years of acute care nursing (e.g. med/surg, telemetry, ICU, Emergency Room or Orthopedics) in a hospital setting within the last five (5) years.
- Per the National Agreement, current KP Coalition employees have this experience requirement waived.
- Bachelors degree in nursing or other related healthcare field; or four (4) years of directly related experience.
- Registered Nurse License (Hawaii)
- Basic Life Support from American Heart Association
- Demonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.
- strong organizational skills and multi-tasking abilities.
- Analytical and interpretive ability of data in daily operations.
- Must be able to work in a Labor/Management Partnership environment.
- Demonstrated knowledge and understanding of CMS guidelines, Medicare and Medicaid rules and regulations.
- Community health, home health or skilled nursing care experience.
- Masters Degree in health care administration, nursing, or related field.
- Preferred Case Manager (CCMA, ACMA, or ANCC).
Basic Qualifications:
Experience
Education
License, Certification, Registration
Additional Requirements:
Preferred Qualifications:
Primary Location: Hawaii,Honolulu,Moanalua Ancillary Building
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Sun, Mon, Tue, Wed, Thu, Fri, Sat
Working Hours Start: 08:00 AM
Working Hours End: 04:30 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: HNA|OPEIU|OPEIU Local 50
Job Level: Individual Contributor
Department: Moanalua Medical Center - Utilization Management - 1201
Pay Range: $72.26 - $72.26 / year
The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No
On-site: Work location is on-site (KP designated office, medical office building or hospital).
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
