Case Manager Extended Care Coord RN-PD

Job Summary

Responsible for the oversight and management of skilled patients and temporary skilled patients in rehabilitation in contracted Skilled Nursing facilities; this includes checking benefits, managing up to discharge and issuing denial letters. With primary care, specialist physicians and healthcare team, coordinates the implementation of a chronic disease care management program for patients. Coordinates with the assigned physician to manage Skilled nursing patients and directs families, patients, physicians, nurse practitioners and SNF staff to the appropriate level of care and identifies those patients who do not meet the criteria for Continued Skilled stay. Responsible for managing Custodial patients who require long term care for chronic disease management in SNFs. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.

• In conjunction with physicians and healthcare team, develops an individual care plan based on patient assessment/evaluation and diagnostic tests.
• Monitors/evaluates patient progress and modifies treatment plan as appropriate in collaboration with the Multidisciplinary team.
• Recommends additional levels of care, therapy/rehabilitation when medically indicated as appropriate.
• Monitors levels and appropriateness of therapeutic and/or rehabilitative care.
• Implements strategies to assure that patients and caregivers comply with and understand the importance of follow through on plan of care in collaboration with the Multidisciplinary team.
• Provides individualized patient/family education which focuses on teaching self management.
• Conducts individual and team conferences to assist patients and family identify risk factors.
• Facilitates patients return to normal daily activities by teaching and making appropriate referrals for outside services/continued care collaboratively.
• In conjunction with physicians and healthcare team, develops treatment program procedures, clinical guidelines/protocols and program evaluation/outcomes measures.
• Educates the Inpatient Case managers about appropriateness of transfers to the Skilled Nursing facility and protocol for transfers.
• Ensures that the patient has a safe and appropriate discharge.
• Orders DME as ordered by the physician.
• Screens by using senior metrics for Skilled patient expected Length of Stay.
• Responsible for educating the Inpatient Case managers/designees about the appropriateness of admissions to the Skilled Nursing facility and protocols for admission.
• Intervenes when there are quality issues surrounding the transfers.
• Notifies members about the co-payment associated with the Skilled Nursing transfer.
• Communicates with physicians and other care givers regarding patient progress by monitoring, evaluating and analyzing clinical, functional and psycho-social status/ progress.
• Issues reports.
• Participates in inter-disciplinary case conferences and consultations.
• Consults with the physician regarding the Senior metrics for the appropriate length of stay for the Skilled population.
• Contributes to medical and nursing staff education by giving periodic in-service presentations.
• Recommended to be present at the inpatient UM staff meetings.
• Participates in review/evaluation of the quality, appropriateness and outcomes of diagnostic and therapeutic services and treatment programs.
• Participates in committees, teams or other work projects/duties as assigned.

Job Summary

Responsible for the oversight and management of skilled patients and temporary skilled patients in rehabilitation in contracted Skilled Nursing facilities; this includes checking benefits, managing up to discharge and issuing denial letters. With primary care, specialist physicians and healthcare team, coordinates the implementation of a chronic disease care management program for patients. Coordinates with the assigned physician to manage Skilled nursing patients and directs families, patients, physicians, nurse practitioners and SNF staff to the appropriate level of care and identifies those patients who do not meet the criteria for Continued Skilled stay. Responsible for managing Custodial patients who require long term care for chronic disease management in SNFs. Complies with other duties as described. Must be able to work collaboratively with the Multidisciplinary team.

• In conjunction with physicians and healthcare team, develops an individual care plan based on patient assessment/evaluation and diagnostic tests.
• Monitors/evaluates patient progress and modifies treatment plan as appropriate in collaboration with the Multidisciplinary team.
• Recommends additional levels of care, therapy/rehabilitation when medically indicated as appropriate.
• Monitors levels and appropriateness of therapeutic and/or rehabilitative care.
• Implements strategies to assure that patients and caregivers comply with and understand the importance of follow through on plan of care in collaboration with the Multidisciplinary team.
• Provides individualized patient/family education which focuses on teaching self management.
• Conducts individual and team conferences to assist patients and family identify risk factors.
• Facilitates patients return to normal daily activities by teaching and making appropriate referrals for outside services/continued care collaboratively.
• In conjunction with physicians and healthcare team, develops treatment program procedures, clinical guidelines/protocols and program evaluation/outcomes measures.
• Educates the Inpatient Case managers about appropriateness of transfers to the Skilled Nursing facility and protocol for transfers.
• Ensures that the patient has a safe and appropriate discharge.
• Orders DME as ordered by the physician.
• Screens by using senior metrics for Skilled patient expected Length of Stay.
• Responsible for educating the Inpatient Case managers/designees about the appropriateness of admissions to the Skilled Nursing facility and protocols for admission.
• Intervenes when there are quality issues surrounding the transfers.
• Notifies members about the co-payment associated with the Skilled Nursing transfer.
• Communicates with physicians and other care givers regarding patient progress by monitoring, evaluating and analyzing clinical, functional and psycho-social status/ progress.
• Issues reports.
• Participates in inter-disciplinary case conferences and consultations.
• Consults with the physician regarding the Senior metrics for the appropriate length of stay for the Skilled population.
• Contributes to medical and nursing staff education by giving periodic in-service presentations.
• Recommended to be present at the inpatient UM staff meetings.
• Participates in review/evaluation of the quality, appropriateness and outcomes of diagnostic and therapeutic services and treatment programs.
• Participates in committees, teams or other work projects/duties as assigned.

Essential Responsibilities

• In conjunction with physicians and healthcare team, develops an individual care plan based on patient assessment/evaluation and diagnostic tests.
• Monitors/evaluates patient progress and modifies treatment plan as appropriate in collaboration with the Multidisciplinary team.
• Recommends additional levels of care, therapy/rehabilitation when medically indicated as appropriate.
• Monitors levels and appropriateness of therapeutic and/or rehabilitative care.
• Implements strategies to assure that patients and caregivers comply with and understand the importance of follow through on plan of care in collaboration with the Multidisciplinary team.
• Provides individualized patient/family education which focuses on teaching self management.
• Conducts individual and team conferences to assist patients and family identify risk factors.
• Facilitates patients return to normal daily activities by teaching and making appropriate referrals for outside services/continued care collaboratively.
• In conjunction with physicians and healthcare team, develops treatment program procedures, clinical guidelines/protocols and program evaluation/outcomes measures.
• Educates the Inpatient Case managers about appropriateness of transfers to the Skilled Nursing facility and protocol for transfers.
• Ensures that the patient has a safe and appropriate discharge.
• Orders DME as ordered by the physician.
• Screens by using senior metrics for Skilled patient expected Length of Stay.
• Responsible for educating the Inpatient Case managers/designees about the appropriateness of admissions to the Skilled Nursing facility and protocols for admission.
• Intervenes when there are quality issues surrounding the transfers.
• Notifies members about the co-payment associated with the Skilled Nursing transfer.
• Communicates with physicians and other care givers regarding patient progress by monitoring, evaluating and analyzing clinical, functional and psycho-social status/ progress.
• Issues reports.
• Participates in inter-disciplinary case conferences and consultations.
• Consults with the physician regarding the Senior metrics for the appropriate length of stay for the Skilled population.
• Contributes to medical and nursing staff education by giving periodic in-service presentations.
• Recommended to be present at the inpatient UM staff meetings.
• Participates in review/evaluation of the quality, appropriateness and outcomes of diagnostic and therapeutic services and treatment programs.
• Participates in committees, teams or other work projects/duties as assigned.

Experience

Basic Qualifications:

• Minimum two (2) years clinical experience as an RN in an acute care setting required.
• ECC Antelope Valley: One (1) year of Utilization Management experience, to include Discharge Planning.

Education

• Please refer to Minimum Work Experience and Qualifications Sections.

License, Certification, Registration

• Registered Nurse License (California)
• Driver's License (California)
• Basic Life Support

Additional Requirements

• 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.
• Computer literacy skills required.

Preferred Qualifications

• Preferred Qualifications:Case Management Certification preferred.
• Bachelors degree in nursing or healthcare related field preferred or current equivalent related work experience.

Primary Location: California,Los Angeles,4950 Sunset Radiation Center

Scheduled Weekly Hours: 1

Shift: Day

Workdays: Mon, Tue, Wed, Thu, Fri

Working Hours Start: 08:30 AM

Working Hours End: 05:00 PM

Job Schedule: Per Diem

Job Type: Standard

Worker Location: Onsite

Employee Status: Regular

Employee Group/Union Affiliation: B21|AFSCME|SCNSC

Job Level: Individual Contributor

Department: Wilshire Admin Offices - Long Term Care (LTC) - 0801

Pay Range: $77.69 - $95.08 / hour

Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data, internal alignment, and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.

Travel: No

Work Setting: Onsite

Worker location must align with Kaiser Permanente's Authorized States policy.

Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.