Case Manager Utilization RN, 40/hr Day

Job Summary Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and continued stays. Makes recommendations to 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‑paced 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 patient’s hospital stay to assure that all appropriate and essential services are delivered timely and efficiently. Participates in Bed Huddles and 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, 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 inpatient 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 identified during case review or other activities. Reviews, analyzes, 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 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. Experience Basic Qualifications Two (2) years combined RN experience in an acute care setting or case management required. Education Completion of an accredited RN training program that allows graduates to take the RN license exam. License, Certification, Registration Registered Nurse 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. Demonstrated ability in planning, organizing, conflict resolution, and negotiating skills. Computer literacy skills required. Preferred Qualifications Bachelor’s degree in nursing or a healthcare‑related field. Notes Alternating weekends and holidays. Primary Location: California, San Diego, Zion Medical Center Scheduled Weekly Hours: 40 Shift: Day Workdays: Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday 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: B21|AFSCME|SCNSC Job Level: Individual Contributor Department: ZION MEDICAL CENTER – Utilization Management – 0801 Pay Range: $64.74 – $79.23 per 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. #J-18808-Ljbffr Kaiser Permanente