Case Manager Utilization RN-PD, Day 7a-5:30p

Kaiser Permanente • Downey, CA

389d

About The Position

The Case Manager Utilization RN is responsible for coordinating patient care in collaboration with physicians and the multidisciplinary healthcare team. This role involves assessing the appropriateness of admissions and continued stays, developing discharge plans, and ensuring compliance with regulatory requirements. The RN acts as a patient advocate, managing care in a cost-effective manner while maintaining quality standards. The position requires multitasking in a fast-paced environment and effective communication with patients, families, and healthcare professionals.

Requirements

• Two years of combined RN experience in an acute care setting or case management.
• Completion of an accredited RN training program that allows graduates to take the RN license exam.
• Registered Nurse License (California).
• Basic Life Support certification.
• Demonstrated ability in utilization review/management, discharge planning, or case management principles.
• Working knowledge of regulatory requirements and accreditation standards.
• Strong written and verbal communication, interpersonal, critical thinking, and problem-solving skills.
• Planning, organizing, conflict resolution, and negotiating skills.
• Computer literacy.

Nice To Haves

• Bachelor's degree in nursing or healthcare-related field.
• BSN/MSN preferred.
• Case Management experience preferred.
• Emergency Department experience preferred.

Responsibilities

• Plans, develops, assesses and evaluates care provided to members.
• Collaborates with physicians and the multidisciplinary healthcare team to develop and document individualized plans of care.
• Recommends alternative levels of care and ensures compliance with regulations.
• Assesses high-risk patients for post-hospital care planning.
• Develops and coordinates discharge plans to meet patient needs and communicates them to relevant parties.
• Reviews and monitors patients' hospital stays to ensure timely and efficient service delivery.
• Participates in Bed Huddles and implements recommendations based on patient needs.
• Coordinates continuity of care including Utilization management and Transfer coordination.
• Conducts daily clinical reviews for utilization and quality management activities.
• Acts as a liaison between inpatient and referral facilities, providing case management to referred patients.
• Refers patients to community resources for post-hospital needs.
• Coordinates patient transfers to appropriate facilities and maintains documentation.
• Adheres to regulatory and accreditation requirements and compliance guidelines.
• Educates healthcare team members on discharge planning roles and resource use.
• Provides patient education to assist with discharge and coping with illness-related issues.
• Reports unusual occurrences related to quality, risk, and patient safety during case reviews.
• Analyzes utilization patterns and participates in data collection for monitoring activities.
• Facilitates care planning rounds and patient family conferences as needed.
• Participates in committees, teams, or other assigned projects.

Benefits

• Health insurance coverage
• Dental insurance coverage
• Vision insurance coverage
• 401k retirement savings plan
• Paid holidays
• Paid time off for volunteering activities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree