Case Manager Utilization RN - Temporary
Posted on: November 25, 2022
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.
- Plans, develops, assesses & evaluates care provided to
- Collaborates with physicians, other members of the
multidisciplinary health care team & patient/family in the
development, implementation & documentation of appropriate,
individualized plans of care to ensure continuity, quality &
appropriate resource use.
- Recommends alternative levels of care & ensures compliance with
federal, state & local requirements.
- Assesses high risk patients in need of post-hospital care
- Develops & coordinates the implementation of a discharge plan to
meet patient's identified needs.
- Communicates the plan to physicians, patient, family/caregivers,
staff & appropriate community agencies.
- Reviews, monitors, evaluates & coordinates the patient's hospital
stay to assure that all appropriate & essential services are
delivered timely & efficiently.
- Participates in the Bed Huddles & carries out recommendations
congruent with the patient's needs.
- Coordinates the interdisciplinary approach to providing
continuity of care, including Utilization management, Transfer
coordination, Discharge planning, & obtaining all
authorizations/approvals as needed for outside services for
- 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 & non-KFH facilities.
- Acts as a liaison between in-patient facility & referral
facilities/agencies & provides case management to patients
- Refers patients to community resources to meet post hospital
- Coordinates transfer of patients to appropriate facilities;
maintains & provides required documentation.
- Adheres to internal & external regulatory & accreditation
requirements & compliance guidelines
including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA &
- Educates members of the healthcare team concerning their roles &
responsibilities in the discharge
planning process & appropriate use of resources.
- Provides patients with education to assist with their discharge &
help them cope with psychological
problems related to acute & 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
- Reviews, analyses & identifies utilization patterns & trends,
problems or inappropriate utilization of resources & participates
in the collection & analysis of data for special studies, projects,
planning, or for routine utilization monitoring activities.
- Coordinates, participates & or facilitates care planning rounds &
patient family conferences as needed.
- Participates in committees, teams or other work projects/duties
as assigned.Basic Qualifications:Experience--- Two (2) years
clinical experience as an RN in an acute care setting
required.Education--- Completion of an accredited RN training
program that allows graduates to take RN license exam.Licenses,
Certifications, Registrations--- Current California RN license
required.--- -BLS. -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.--- Demonstrated ability in planning,
organizing, conflict resolution and negotiating skills.--- Computer
literacy skills required. -Preferred Qualifications:--- Bachelor's
degree in nursing or healthcare related field preferred.
Works every other weekend This is a
temporary position for approximately three (3) months.Job Schedule:
Job Category: Nursing Licensed & Nurse Practitioners
Keywords: Kaiser, Hemet , Case Manager Utilization RN - Temporary, Executive , Hemet, California
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