Case Manager OS Utilization RN
Posted on: March 18, 2023
Coordinates continuing care/outside services for continuing care
members at one medical center. Repatriate stable Kaiser Permanente
members from non-Kaiser Permanente facilities in the emergency
department and admitted patients. The process involves screening
for appropriateness of care and talking to the outside physician to
establish stability to transfer to a Kaiser Permanente facility.
Works with KFH and SCPMG staff in developing service plans,
providing quality care, cost effective services that are aligned
with federal, state and local regulations and continuing care
business goals/objectives. Complies with other duties
- Coordinates the administration and delivery of assigned outside
services at one medical center.
- Collaborates with physicians, service directors, and other
health care providers to identify and implement innovative models
and best practices, emphasizing service improvements and cost
- Develops and implements quality and utilization standards to
ensure coordinated plans of treatment, customer focused delivery of
services and cost effective utilization of necessary services.
- Ensures compliance with administrative, legal and regulatory
requirements of the Health Plan contract and governmental
regulatory and accrediting agencies.
- Develops and enhances unit based standards as identified by
- Provides services that meet standards for customer satisfaction
with emphasis on customer service, quality and innovation.
- Acts as liaison with non-plan providers.
- Develops and expands relationships with
- Utilizes research data to implement service changes and improve
the delivery of patient care and member outside services.
- Identifies and recommends opportunities for cost savings and
improving the quality of care and service.
- Participates in committees, teams or other work projects/duties
as assigned.Basic Qualifications:--Experience
- Minimum two (2) years clinical experience as an RN in Critical
Care or case management required.
- For positions in KP Reconnect & Transitional Care Case
Management Program only (substitute first sentence above): Minimum
two years clinical experience as an RN in Acute Care or case
- For positions in Centralized Behavioral Health Care (Psych)
Utilization Mgmt: (substitute first sentence above): Minimum two
years clinical experience as an RN in Acute Care Psych or psych
case management required.--Education
- Please refer to Minimum Work Experience and Qualifications
Sections.--License, Certification, Registration
- Registered Nurse License (California)--Additional Requirements:
- Demonstrated ability to utilize/apply the general and
specialized principles, practices, techniques, and methods of
utilization review/management, discharge planning and case
- Working knowledge of regulatory requirements and accreditation
standards (TJC, Medicare, Medi-Cal, etc.).
- Demonstrated ability to utilize written and verbal
communication, interpersonal, critical thinking and problem-solving
- Computer literacy skills required.--Preferred Qualifications:
- Bachelors degree in nursing or healthcare related field
- Every other weekend
- If twelve (12) hour option chosen, shift will be 9:00 am-9:30
pm, back up 8 hour shift will be 9:00 am to 5:30 pm.--Job Schedule:
Job Category: Nursing Licensed & Nurse Practitioners
Keywords: Kaiser, Orange , Case Manager OS Utilization RN, Healthcare , Orange, California
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