Case Manager

Please be aware that this position is currently under review as part of the jurisdictional process with the California Nurses Association to determine whether such position should be assigned to the CNA bargaining unit. This review is on a position-by-position basis and includes an analysis of the actual duties performed in each position under review. This determination will be made within the next several months. Should the determination be made that the position does belong to the CNA bargaining unit, you will be offered the opportunity to (a) follow the work into the CNA bargaining unit and become a member of the union, or (b) seek other employment within the organization. Should you have any questions regarding this notice, please contact your recruiter for further information
Coordinates w/ physicians, staff, non-Kaiser providers facilities regarding patient care. In conjunction w/ physicians, develops treatment plan, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, develops guidelines for care.

Essential Functions:
- Plans, develops, assesses, evaluates care provided to members.
- In conjunction w/ physicians, evaluates develops treatment plans, recommends alternative levels of care, ensures compliance w/ federal, state, local requirements.
- Develops maintains case management policies procedures.
- Coordinates, directs, performs concurrent retrospective reviews, monitors level quality of care.
- Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, obtaining all authorizations/approvals as needed for outside services for patients/families.
- Consults w/ internal external physicians, health care providers, discharge planning outside agencies regarding continued care/treatment or hospitalization.
- Arranges monitors follow-up appointments.
- Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy).
- Makes referrals to appropriate community services.
- Identifies recommends opportunities for cost savings improving the quality of care across the continuum.
- Develops collects data, trends utilization of health care resources.
- Interprets regulations, health plan benefits, policies, procedures for members, physicians, medical office staff, contract providers, outside agencies.
- Coordinates transmission of clinical benefit treatment to patients, families outside agencies.
- Acts as liaison for outside agencies, non-plan facilities, outside providers.
- Coordinates repatriation of patients monitors their quality of care.

Secondary Functions: Position involves travel to hospital and other settings where patients reside.
Qualifications:
Basic Qualifications:
- Previous case management experience preferred.
- Experience in utilization management, discharge planning, or transfer coordination.
- Bachelor's degree, or equivalent experience, in nursing or health related field.
- Masters degree preferred.
- Graduate of an accredited school of nursing.
- Current California RN license required.
- PHN preferred.
- Knowledge of Nurse Practice Act, The Joint Commission other federal/state/local regulations.

Preferred Qualifications:
- Previous experience (usually 2 years) in care management or clinical experience and responsibility for a large caseload (50-100) for an extended period of time.
- A minimum of two years of clinical experience working with severely ill Psychiatric Patients including children, adolescents/young adults, and adults with chronic conditions in inpatient or outpatient settings.. Demonstrated expertise in crisis management.
- Demonstrated experience in utilization data collection and cost benefit analysis.
- Knowledge of The Joint Commission, and other local, state, and federal regulations.
- Must be able to work in a Labor/Management Partnership environment.