Case Manager Utilization RN - Per Diem - Days
Posted on: November 26, 2022
Works collaboratively with an MD to coordinate and screen for
the appropriateness of admissions and Continued stays. Makes
recommendations to the physicians for alternate levels of care when
the patient does not meet the medical necessity for Inpatient
hospitalization. Interacts with the family, patient and other
disciplines to coordinate a safe and acceptable discharge plan.
Functions as an indirect caregiver, patient advocate and manages
patients in the most cost effective way without compromising
quality. Transfers stable non-members to planned Health care
facilities. Responsible for complying with AB 1203, Post
Stabilization notification. Complies with other duties as
described. Must be able to work collaboratively with the
Multidisciplinary team, multitask and in a fast pace environment.
- Plans, develops, assesses and evaluates care provided to
- Collaborates with physicians, other members of the
multidisciplinary health care team and patient/family in the
development, implementation and documentation of appropriate,
individualized plans of care to ensure continuity, quality and
appropriate resource use.
- Recommends alternative levels of care and ensures compliance with
federal, state and local requirements.
- Assesses high risk patients in need of post-hospital care
- Develops and coordinates the implementation of a discharge plan
to meet patient's identified needs; communicates the plan to
physicians, patient, family/caregivers, staff and appropriate
- Reviews, monitors, evaluates and coordinates the patient's
hospital stay to assure that all appropriate and essential services
are delivered timely and efficiently.
- Participates in the Bed Huddles and carries out recommendations
congruent with the patient's needs.
- Coordinates the interdisciplinary approach to providing
continuity of care, including Utilization management, Transfer
coordination, Discharge planning, and obtaining all
authorizations/approvals as needed for outside services for
- Conducts daily clinical reviews for utilization/quality
management activities based on guidelines/standards for patients in
a variety of settings, including outpatient, emergency room,
inpatient and non-KFH facilities.
- Acts as a liaison between in-patient facility and referral
facilities/agencies and provides case management to patients
- Refers patients to community resources to meet post hospital
- Coordinates transfer of patients to appropriate facilities;
maintains and provides required documentation.
- Adheres to internal and external regulatory and accreditation
requirements and compliance guidelines including but not limited
to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOL.
- Educates members of the healthcare team concerning their roles
and responsibilities in the discharge planning process and
appropriate use of resources.
- Provides patients with education to assist with their discharge
and help them cope with psychological problems related to acute and
- Per established protocols, reports any incidence of unusual
occurrences related to quality, risk and/or patient safety which
are identified during case review or other activities.
- Reviews, analyses and identifies utilization patterns and trends,
problems or inappropriate utilization of resources and participates
in the collection and analysis of data for special studies,
projects, planning, or for routine utilization monitoring
- Coordinates, participates and or facilitates care planning rounds
and patient family conferences as needed.
- Participates in committees, teams or other work projects/duties
as assigned.Basic Qualifications:Experience--- Two (2) years of
clinical experience as an RN in an acute care setting
required.Education--- Completion of an accredited RN training
program that allows graduates to take RN license exam.License,
Certification, Registration--- Current California RN license
required.--- BLS. - -Additional Requirements:--- Demonstrated
ability to utilize/apply the general and specialized principles,
practices, techniques and methods of Utilization review /
management, discharge planning or case management.--- 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 skills.--- Demonstrated ability in planning,
organizing, conflict resolution and negotiating skills.--- Computer
literacy skills required.Preferred Qualifications:--- Bachelor's
degree in nursing or health care related field preferred.
- BSN preferred.
- Acute care management hospital experience preferred.Notes:
- This assignment is a UM Dept CM position IP. -Job Schedule: Job
Category: Nursing Licensed & Nurse Practitioners
Keywords: Kaiser, Fontana , Case Manager Utilization RN - Per Diem - Days, Healthcare , Fontana, California
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