Patient Care Coordinator
5 months ago
EssentialResponsibilities
- Utilization Management: Performsdaily pre-admission, admission, and concurrent utilization reviewsusing guidelines, institutional policies/procedures, and otherinformation to determine appropriate levels of care and readinessfor discharge.
- Monitors the progression of thedischarge plan and facilitates discussions with themultidisciplinary teams.
- Educates otherhealthcare team members on utilization and carecoordination.
- Collaborates with and providesinformation to patients, families, physicians, and staff regardingthe discharge plans andtransitions.
- Understands and consistentlyapplies the interpretation, and utilization of member health carebenefits.
- Conducts UM, care coordination anddischarge planning activities according to all applicableregulatory requirements.
- Discharge Planning:Ensures continuity of care through communication in rounds andwritten documentation, level of care recommendations, transfercoordination, discharge planning and obtainingauthorizations/approvals as needed for outside services for thepatient.
- Develops, evaluates, and coordinates acomprehensive discharge plan in conjunction with thepatient/family, physician, nursing, social services, and otherhealth care providers and agencies.
- Regulatory:Conducts UM, care coordination, and discharge planning activitiesaccording to all applicable regulatoryrequirements.
- Kaiser Permanente conductscompensation reviews of positions on a routine basis. At any time,Kaiser Permanente reserves the right to reevaluate and change jobdescriptions, or to change such positions from salaried to hourlypay status. Such changes are generally implemented only afternotice is given to affected employees.
Experience
BasicQualifications:
- Minimum four (4) years of experiencein hospital patient care delivery, OR completion of Masters degreein case management program in lieu of minimum years ofexperience.
Education
- Graduate of accredited school ofnursing.
- Diploma/Associate DegreeNursing.
License,Certification, Registration
- Registered Nurse License(California)
- Basic Life Support
AdditionalRequirements
- Knowledge of the Nurse Practice Act,TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all otherapplicable federal/state/local laws ®ulations.
- Demonstrated strong communicationand customer service skills, problem-solving, critical thinking,& clinical judgmentabilities.
- Fundamental word processing& computer navigation skills & the ability tointerpret & use analytic data in day to dayoperations.
- Knowledge of health care benefitsassociated with various business line (Medicare/KPSA,Commercial/KFH, Medi-Cal, Federal, etc.).
- Mustbe able to work in a Labor/Management Partnershipenvironment.
PreferredQualifications
- Minimum two (2) years of experiencein utilization review, case management, and discharge planningpreferred.
- Bachelors degree in nursing or ahealth care related field preferred.
- Mastersdegree in case managementpreferred.
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