Case Management Utilization RN

Kaiser Permanente

$121K — $148K *


2w ago


Less than 5 years of experience

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Job Description

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.

Essential Responsibilities:

  • Plans, develops, assesses and evaluates care provided to members.

  • 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 planning.

  • Develops and coordinates the implementation of a discharge plan to meet patients identified needs.

  • Communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies.

  • Reviews, monitors, evaluates and coordinates the patients 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 patients 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 patients/families.

  • 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 referred.

  • Refers patients to community resources to meet post hospital needs.

  • 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 chronic illness.

  • 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 activities.

  • 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:


  • Two (2) years combined RN experience in an acute care setting or case management required.


  • Completion of an accredited RN training program that allows graduates to take RN license exam.

License, Certification, Registration

  • Registered Nurse License (California)

  • Basic Life Support

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:

  • Bachelors degree in nursing or healthcare related field.


  • Rotating weekends, Inpatient.

Primary Location: California,Panorama City,Panorama City Medical Center Scheduled Weekly Hours: 20 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: 08:00 AM Working Hours End: 08:00 PM Job Schedule: Part-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: B21|AFSCME|SCNSC Job Level: Individual Contributor Department: Panorama City MOB #4 - Utilization Management - 0801 Pay Range: $58.43 - $71.51 / 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 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
Kaiser Permanente is a healthcare organization that provides health insurance and medical care to members in several states across the United States. The organization was founded in 1945 and is headquartered in Oakland, California. Kaiser Permanente operates hospitals, medical centers, and clinics, and offers a range of services including primary care, specialty care, and emergency care. The organization is known for its integrated healthcare model, which combines health insurance and medical care in a single system. Kaiser Permanente is also committed to promoting health equity and addressing social determinants of health, such as housing and food insecurity.
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