Kaiser Permanente-posted 3 months ago
Sacramento, CA
Ambulatory Health Care Services

Provides case management services to a caseload of low- and medium-risk patients. Interviews patients and their caregivers to evaluate needs, goals, and current services. Proposes process improvements for determining initial eligibility, benefits, and education for all admissions, leveraging advanced knowledge to assess medical necessity and required level of care to inform physicians. Analyzes and ensures authorization data and escalates inaccuracies. Develops a client-focused case management plan in collaboration with healthcare team, patient, and caregivers that is consistent with regulatory, accreditation, and regional guidelines. Assists patients with gaining access to care based on their needs, making referrals as appropriate. Coordinates resources and services to assure continuity and quality of care. Attends case management rounds with clinician and updates authorizations and diagnoses as needed. Assesses patient progress toward treatment milestones and care plan goals. Identifies barriers to achieving goals and ensures that they are discussed with the patient and care team thoroughly. Verifies that all services remain consistent with established guidelines and standards. Documents the patients case in all medical files. Reviews benefits/services available to patients, caregivers, and other members of the community and addresses identified concerns. Connects patients and caregivers with the right entities to assist with benefits/coverage needs. Identifies patients ready for disposition planning activities. Develops and communicates a comprehensive disposition plan in collaboration with the patient, caregivers, physician, nurses, social services, and other healthcare providers and agencies. Obtains authorizations as needed for patient services. Recommends and attends professional seminars, workshops, and approved educational programs and workshops. Monitors and reviews operational team data and key metrics applied to own work. Makes suggestions for change or improvement as needed. Ensures adherence to regulatory requirements by implementing policy updates.

  • Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members.
  • Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers.
  • Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses.
  • Adopts new responsibilities; adapts to and learns from change, challenges, and feedback.
  • Facilitates team collaboration to support a business outcome.
  • Completes work assignments autonomously and supports business-specific projects.
  • Collaborates cross-functionally and/or externally to achieve effective business decisions.
  • Supports the development of work plans to meet business priorities and deadlines.
  • Identifies, speaks up, and capitalizes on improvement opportunities across teams.
  • Drives services related to the initial case assessment by interviewing patients and their families.
  • Provides services related to monitoring and evaluating plan of care.
  • Drives services related to the case-planning process by creating a client-focused case management plan.
  • Supports efforts to remain updated on current research, policies, and procedures.
  • Provides services related to patient disposition by developing, evaluating, coordinating, and communicating a comprehensive disposition plan.
  • Connects patients with existing services by guiding others to assist patients with gaining access to care.
  • Serves as liaison between internal and external care.
  • Bachelors degree in Nursing or related field.
  • Minimum five (5) years of experience in nursing, case management, or a directly related field.
  • Registered Nurse License (California) required at hire.
  • Knowledge, Skills, and Abilities (KSAs): Information Gathering.
  • Written Communication.
  • Confidentiality.
  • Health Care Compliance.
  • Maintain Files and Records.
  • Acts with Compassion.
  • Business Relationship Management.
  • Company Representation.
  • Managing Diverse Relationships.
  • Relationship Building.
  • Member Service.
  • Patient Safety.
  • Health Care Quality Standards.
  • Quality Assurance and Effectiveness.
  • Community Health.
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