Reg Mgr RN Care Coord & Case Mgt-MediCal
Company: Kaiser
Location: Pasadena
Posted on: May 3, 2024
Job Description:
The incumbent will be responsible for the day-to-day management
and supervision of the Regional Care Coordination and Case
Management department, including program development,
implementation, monitoring, performance improvement, and management
of the Care Coordination and Case Management Team which may consist
of clinical e.g. RN, LVN, LCSW, MSW, and allied health and
non-clinical staff. In addition, the incumbent will be working in
collaboration with regional and medical center leaders and
physicians to provide integrated, seamless, and patient centric
care and services, monitoring and evaluation of program outcomes
achieved.
Essential Responsibilities:
- Manages the day-to-day operations of the Regional Care
Coordination / Case Management department and team members.
Partners with team leads to drive day to day operations.
- Provides operations oversight of care coordination, case
management, and care transition functions.
- Collaborates with internal and external physicians, health care
providers, discharge planners, other care managers and outside
agencies to ensure that continued care/treatment or hospitalization
or referral to support services or placement is available to
program members.
- Ensures that all operational program activities follow the KP
benefits, policy, and with the various regulatory agencies involved
with the management and monitoring of medical care and
reimbursement and with government legislative directives.
- Provides oversight on strategies set by case managers to
target/assess risk factors and achieve and ensure patient follow up
according to clinical and strategic measures/outcomes.
- Ensures adherence to case management policies and
procedures.
- Ensures appropriate development and implementation of case
management plans. Ensures that case managers are developing
individualized patient/family education plans focused on self-care
management.
- Ensures that case managers coordinate care/services with
utilization and/or quality reviewers and monitors level and quality
of care.
- Manages the administrative functions of the Care Coordination
and Case Management operations, including space
planning/management, identification/proposals for system
development/enhancements, recruiting, hiring, training,
discipline/reward and termination of Care Coordination/Case
Management department staff.
- Monitors, reviews, analyzes, and maintains accurate data as it
relates to outcomes, effectiveness of case management plans, and
trends. Oversees the participation by case managers with healthcare
team/providers in actualizing outcomes by planning, evaluating, and
implementing decisions and strategies to achieve predetermined
cost, clinical, quality, utilization, and service outcomes.
- Participates and prepares regulatory audits.
- Trains case managers on the interdisciplinary approach to
providing continuity of care, including utilization management,
transfer coordination, discharge planning, and obtaining all
authorizations/approvals/transfers as needed for outside services
for patients/families.
- Works closely with groups across the continuum, including but
not limited to Inpatient Case Management, Long Term Care/Skilled
Nursing, medical group operations, Quality, Chiefs Groups, to share
information and solicit feedback.
- Liaisons with other functional groups, including but not
limited to, UM Directors, PCM Leaders, Assistant Administrators,
Continuing Care, Social Medicine, Long Term Care, Palliative Care,
Home Health/ Hospice, to share information and solicit feedback
Prepares written and verbal reports on program status, outcome
metrics and other deliverables to designated regional and local
senior leaders, committees and groups.
- Tracks program and case manager productivity and creates
performance plan if needed. Serves as clinical resource for
escalation questions or concerns by case managers & pharmacists.
Creates monthly productivity for each program and develops action
plan for areas with low performance.
- Performs other duties as assigned.
- Basic Qualifications:
Experience
- Minimum three (3) years of supervisory/management experience
required. Education
- Bachelors degree in nursing, health administration or public
health required.
- Graduate of an accredited school of nursing. License,
Certification, Registration
- Registered Nurse License (California) Additional Requirements:
- Knowledge and expertise in case management scope of practice,
technique and community resources.
- Strong conformability with KPHC and the implementation of new
modules within KPHC
- Demonstrated knowledge of case management, discharge planning,
transition of care, transfer coordination; Medicare, Medicaid,
Title 22, NCQA, JCAHO, URAC, and other federal/state/local
regulations.
- Skilled collaborator and team builder.
- Ability in planning, organizing, conflict resolution,
negotiating and interpersonal skills.
- Knowledge regarding compliance requirements by the various
regulatory agencies and various legislative directives affecting
health care management and reimbursement.
- Excellent communication skills, good problem-solving skills,
and decision-making skills; PC skills to include Microsoft word,
excel, power point, and electronic medical record.
- Strong customer service orientation required.
- Must be able to work in a Labor/Management Partnership
environment. Preferred Qualifications:
- Minimum five (5) years of case management, or care management
experience preferred.
- Extensive program development and program management experience
in health care provider/payer setting preferred.
- Masters degree in nursing or related healthcare field
preferred.
- Certification as a case manager preferred with experience in
home health, discharge planning, utilization management, and/or
ambulatory case management desired.
Notes:
--- Occasional weekends.
PrimaryLocation : California,Pasadena,East Annex - Parsons
HoursPerWeek : 40
Shift : Day
Workdays : Mon - Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-SCAL-01 NUE Non Union
Employee
Job Level : Manager with Direct Reports
Job Category : Nursing Licensed & Nurse Practitioners,RN
Manager
Department : Regional Offices - Pasadena - Medicaid Improvemnt
Initiative - 0801
Travel : No
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.
Keywords: Kaiser, Pasadena , Reg Mgr RN Care Coord & Case Mgt-MediCal, Healthcare , Pasadena, California
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