Patient Care Coordinator/Case Manager Job in Stockton, California Us
Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care. In conjunction with physicians, develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost-effective protocols, and develops guidelines for care.
Essential Functions:
Utilization Management
- Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.
- Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately.
- Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams.
- Educates other health care team members on utilization and cost containment initiatives.
- Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care.
- Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care).
Discharge Planning
- Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.
- Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies.
Performance Improvement
- Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols.
- Participates in the development and implementation of guidelines, preprinted physician orders, care paths, etc. for patient care.
- Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum.
- Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-day stays, DRGs, LOS, etc.
- Participates in the development, implementation, communication, maintenance and monitoring of local UM Work plan initiatives.
Administrative and Regulatory
- Shares accountability with the UM Manager for planning, developing, and managing the department budget.
- Participates in interviewing, makes hiring recommendations, orients and provides on-going supervision of support staff.
- Provides input into the performance evaluations of team members.
- May plan and control work assignments and special projects of team members.
- Assists in developing, implementing and maintaining utilization management policies and procedures.
- Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements (see qualifications).
Qualifications:
Basic Qualifications:
- Experience (usually 2+ years) in direct patient care delivery management.
- Demonstrated experience in utilization review, case management, discharge planning preferred (usually 2+ years).
- BSN or BA in health care related field or Diploma/Associate Degree Nursing (ADN) w/ comparable years of experience required.
- Masters Degree preferred.
- Graduate of accredited school of nursing.
- BLS certification and current California RN licensure required.
- Demonstrated strong communication customer service skills, problem-solving, critical thinking, clinical judgment abilities.
- Fundamental word processing computer navigation skills the ability to interpret use analytic data in day to day operations.
- Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA all other applicable federal/state/local laws regulations.
- Knowledge of healthcare benefits associated w/ various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).
Preferred Qualifications:
- Prior electronic medical record experience.
- 1-3 years Health Plan or Hospital case management or discharge planning experience within last 5 years.
- Familiar with InterQual screening tools.
Schedule: 8:00 AM - 5:00 PM
This position based in Stockton at Dameron Hospital. Varied scheduled days and hours, every other weekend, 12 and 8 hour shifts to cover schedule. May be asked to cover other shifts (7:00 AM - 7:00 PM, 7:00 PM - 7:00 AM, etc.) due to operational needs. May be asked to float to other hospitals in the CVA to provide coverage.