Case Manager Utilization RN, 40/hr Day
Ventura, CaliforniaOur nurse leaders maintain a strong commitment to the highest standards of professional nursing practice and to sustain a culture of excellence. You will encourage your teams to use evidence-based practice to deliver high-quality patient care, contribute to research, and spread innovation beyond Kaiser Permanente. Backed by the resources of one of the nation’s largest health care providers, you’ll motivate and inspire your team to achieve goals, value individual contributions, and celebrate accomplishments in meaningful ways while realizing your own potential as a leader.
- Job Type: Full-time
- Job Level: Individual Contributor
- Travel: No
Success Profile
We’re looking for Nurse Leaders who possess the following traits.
- Adaptable
- Collaborative
- Compassionate
- Leadership
- Problem-Solver
- Results-Oriented
Benefits
Our compensation and benefits are designed to help you and your family stay healthy and thrive.
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Medical, Vision & Dental
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Retirement Plans
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Tuition Reimbursement
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Tuition Reimbursement
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Supportive Team & Resources
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Career Growth & Development
Our Culture
Our Nurse Leaders cultivate an environment of compassion, integrity, trust, and open communication that helps our teams do their best work. Together, we pursue lifelong learning in the belief that it expands our knowledge so we can better serve our patients. We participate in research to inform our evidence-based care. Our nurses reflect the rich diversity of our members and communities, and provide culturally responsive and competent care that promotes the understanding of our members’ needs and preferences. At Kaiser Permanente, nurses are highly skilled professionals who exemplify leadership, critical thinking, and collaborative problem-solving, and deliver the right care, at the right time, in the right setting.
What Our People Are Saying
Ghada, PhD, RN, NEA-BC, CENP
SCAL Regional Director
Patient Care Services
“So proud to be a Kaiser Permanente nurse leader. Despite all the challenges we experienced with the pandemic, we remained true to our mission to provide safe, quality care to our patients and members, and continue to encourage our employees to grow and develop professionally. I have completed my Doctor of Philosophy in Nursing and lead with an exceptional team. There are boundless opportunities here.”
Gertrude, RN, BSN, MSA
Administrative Service Director
Nursing Administration
“Kaiser Permanente has a mission of providing affordable health care not just for our members, but also the community — which is a passion of mine. I consider myself very fortunate to work for an organization that values their employees. As a nurse leader, I LOVE what I do! We provide endless possibilities for growth and professional development.”
Michele, JD, MBA, RN
Director
Nursing Professional Development and
Simulation/Magnet Journey
“Kaiser Permanente provides its nurse leaders with opportunities to innovate and thrive in an evidence-based practice that’s advancing the science of nursing and embracing a culture of excellence.”
Philidah, MSN, RN
Sr. Director of Nursing
“It’s a privilege to work for Kaiser Permanente. They support nurses through a variety of learning opportunities, from self-paced learning to leadership courses and stretch assignments. It enables equitable opportunities for professional growth and career advancement.”
Mervin
Assistant Medical Center Administrator
“I’m incredibly grateful for the support I received from Kaiser Permanente. I would not be where I am right now without the mentoring from outstanding leaders, the strong relationships I built with my team, and the partnership with other departments.”
Melissa
Assistant Nurse Manager
“I’m in my first position here, but I’ve already had the opportunity to be part of the Magnet Journey, quality and safety committees, and co-chair Professional Nursing Excellence Council. Kaiser Permanente continues to help me grow through leadership training programs like Activate and stretch assignments.”
Aletha
Department Manager
“Kaiser Permanente has many resources and tools to help us grow professionally. We have courses and financial aid for individuals who choose to advance.I love being a leader because I love to encourage, inspire, and develop my team. I also embrace challenges and enjoy collaborating in projects that positively impact our members.”
Adriana
Department Manager RN
“Kaiser Permanente allows me to focus on preventive health care, which contrasts with my acute care background. I appreciate the preventive care services that we offer our members and the different forms of communication based on personal preference.”
Case Manager Utilization RN, 40/hr Day
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Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts with the family, patient and other disciplines to coordinate a safe and acceptable discharge plan. Functions as an indirect caregiver, patient advocate and manages patients in the most cost effective way without compromising quality. Transfers stable non-members to planned Health care facilities. Responsible for complying with AB 1203, Post Stabilization notification. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team, multitask and in a fast pace environment.
Essential Responsibilities:
- Plans, develops, assesses and evaluates care provided to members.
- Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use.
- Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
- Assesses high risk patients in need of post-hospital care planning.
- Develops and coordinates the implementation of a discharge plan to meet patients identified needs.
- Communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies.
- Reviews, monitors, evaluates and coordinates the patients hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
- Participates in the Bed Huddles and carries out recommendations congruent with the patients needs.
- 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.
- Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non-KFH facilities.
- Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
- Refers patients to community resources to meet post hospital needs.
- Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation.
- Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOL.
- Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
- Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
- Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities.
- Reviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
- Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed.
- Participates in committees, teams or other work projects/duties as assigned.
- Two (2) years combined RN experience in an acute care setting or case management required.
- Completion of an accredited RN training program that allows graduates to take RN license exam.
- Registered Nurse License (California)
- Basic Life Support
- Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management.
- Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
- Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills.
- Demonstrated ability in planning, organizing, conflict resolution and negotiating skills.
- Computer literacy skills required.
- Bachelors degree in nursing or healthcare related field.
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.
For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:
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