Lead Coordinator Patient Care -Continuing Care - Case Manager

Company: Gelsi Ltd
Location: Honolulu
Posted on: September 13, 2020

Job Description:

Important Update: In response to the COVID-19 pandemic, Kaiser Permanente is moving to a virtual recruitment process including telephone and video interviews to help ensure the health and safety of our employees, candidates, and communities. Also, some hiring activities may be delayed or suspended in certain geographic areas and job categories. For more information on Kaiser Permanente’s response to COVID-19, visit our Resource Center .

Our nurse professionals embody what it means to provide the best patient interactions possible. They also advance the art and science of nursing in a patient-centered, healing environment.

Lead Coordinator Patient Care -Continuing Care - Case Manager Submit Interest Location: Honolulu, HI Additional Locations:

Job Number: 855755 Date posted: 03/04/2020 Description:

Serves as lead for Utilization Management (UM) of Continuing Care. Assists UM Manager with the management of the department, and assists in developing, implementing and maintaining utilization management policies and procedures. Trains, monitors, and counsels assigned staff. 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. Analyzes data relevant to the utilization of healthcare resources. Participates in the development, implementation, communication, maintenance and monitoring of local UM Workplan initiatives.

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.

Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources. Participates in the development, implementation, communication, maintenance and monitoring of local UM Workplan initiatives. Serves as lead for Utilization Management (UM) of Continuing Care. Shares accountability with the UM Manager for planning, developing, and managing the department budget. Trains, monitors, and counsels assigned staff. Recommends and provides input for performance evaluation, hiring, disciplining and termination of assigned staff as appropriate. Reports problems to supervisor, and assists in resolution. May plan and control work assignments and special projects of team members. Assists in developing, implementing and maintaining utilization management policies and procedures.

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.

Basic Qualifications:

Experience

Minimum two (2) years of experience in utilization review, case management, and discharge planning.

Education

Bachelor's degree in nursing; OR four (4) years of directly related experience.

License, Certification, Registration

Valid Hawaii RN license (must meet education requirement(s) for Hawaii State licensure).

Current BLS for Healthcare Provider CPR or CPR/AED for the Professional Rescuer certification.

Additional Requirements:

Demonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.

Analytical and interpretive ability of data in daily operations.

Preferred Qualifications:

Case management experience.

Supervisory/lead or project management experience.

Master's degree in health care administration, nursing, or related field.

Primary Location: Hawaii,Honolulu,Hospital/Medical Offices 3288 Moanalua Rd. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: 8:00 AM Working Hours End: 4:30 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Hawaii Nurses Association Job Level: Individual Contributor Job Category: Nursing Licensed Department: Utilization Management Travel: Yes, 5 % of the Time 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.

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

Click here for additional requirements >

Submit Interest

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Keywords: Gelsi Ltd, Honolulu , Lead Coordinator Patient Care -Continuing Care - Case Manager, Other , Honolulu, Hawaii