Description: *** SIGN-ON BONUS OF $5K AVAILABLE TO ELIGIBLE EXTERNAL HIRES - TEAM WILLING TO TRAIN! *** Onsite - Combination Inpatient and Advanced Urgent Care Discharge Planning - Kaiser Permanente - Capitol Hill/Seattle WA EVERY OTHER WEEKEND AND VARIABLE WEEK DAYS ROTATING HOLIDAYS Job Summary: The Care Manager will work in 2 settings on a periodic rotating schedule, planning the discharges and follow up care for Kaiser Foundation Health Plan of Washington patients hospitalized at a nearby network facility and carrying a case load of patients in one of the Kaiser Foundation Health Plan of Washington medical centers. Some weekends and holidays are required, and scheduled days of the week are variable. Primary responsibility is to focus on achievement of optimal patient health care outcomes while ensuring appropriate utilization of health care resources. Working closely with primary care teams, specialty care teams and medical providers, the Liaison Nurse will establish a collaborative plan of care to assure adherence to the medical plan, improvement in functional status, and improved ability to self-manage. Serves as the liaison across the internal KFHPW care continuum and between KFHPW and all externally contracted providers, facilities, and resources and provides feedback to the organization regarding the service and quality of contracted services. The Liaison Nurse collects data and provides input to leadership regarding issues or concerns related to utilization, cost, quality, service and care delivery to patients.
Essential Responsibilities: - Ensures patients referred to case management meet established case management criteria.
- Assess all patients referred for case management to determine physical, mental, financial, psychosocial status, utilizing comprehensive, standardized criteria to identify existing and potential needs.
- Develop patient centered case management plan based on assessments and including patient goals, objectives, and outcomes with specific time frames (long/short term).
- Evaluate ability and availability of designated caregiver(s) to provide patient support.
- Coordinate and implement interventions using evidence-based guidelines.
- Recommend additional services to PCP as determined in the case management plan.
- Conduct ongoing assessment of progress against original goals.
- Continuously update needed services.
- Maintain ongoing communication with patient/family and care team.
- Acts as an advocate for patient care needs.
- Documents all responses of patient to case management interventions.
- Collaborates with other health care professionals regarding the plan of care, variances in plan implementation, achieved outcomes or expected outcomes.
- Monitor and evaluate short- and long-term patient responses to therapeutic interventions and analyze patterns of variance from clinical information and outcomes.
- Recommend alternative settings for care based on health care needs and appropriate utilization of health care resources.
- Document interventions and interactions with patients or caregivers according to KFHPW and Care Management policy and procedure.
- Participate in the measurement of the effectiveness of the case management program.
- Directs and guides the plan of care to result in a seamless continuum of care.
- Facilitates as needed, referrals for home health care, long term care, hospice, and other care facilities or services.
- Participation in care conferences to provide problem solving for patients with complex care needs (limited basis).
- Collects needed data needed to evaluate the effects of care coordination on quality outcomes, fiscal parameters, patient satisfaction and systems improvement.
- Understands and utilizes health plan requirements and patient benefits in making care management decisions.
- Assists patient to understand and comply with their medical treatment plan.
- Supports patient education and activation through referral to specific chronic illness classes, group visits or community resources.
Basic Qualifications: Experience
- Minimum three (3) years of recent RN medical/surgical/ambulatory clinical experience required.
Education
- Bachelors degree or bachelors of science.
License, Certification, Registration
- Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire
- Case Manager Certificate within 24 months of hire
- Basic Life Support required at hire
Additional Requirements: - Effective, independent nursing judgment and skills, and use of evidence based clinical decision making criteria.
- Knowledge in management of chronic disease process, nursing process and collaborative care planning.
- Demonstrated skill and experience in effectively collaborating with care team members.
Preferred Qualifications: - Minimum two (2) years of RN experience in utilization review, ambulatory case management, care coordination or disease management.
- Bachelors of science in nursing.
Primary Location: Washington,Seattle,Capitol Hill Main Building
Additional Locations: Washington
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 09:00 AM
Working Hours End: 07:30 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: J01|SEIU|SEIU Local 1199 RN/ANRP
Job Level: Individual Contributor
Department: Renton Admin Baker - UR-Discharge Planning - 1130
Pay Range: $44.06 - $74.29 / hour The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No
On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
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. Submit Interest