Care Manager, Inpatient
Posted on: November 25, 2022
Inpatient Care Manager are Registered Nurses who independently
assure patients are admitted to the correct level of care for
accurate billing and reimbursement, provide quality, cost effective
clinical coordination/care management in the acute care and
emergency care settings, manage patients with routine and complex
discharge planning needs by: independently assessing needs,
developing and implementing plans of care for transitions across
care settings. Inpatient Care Manager also serve as expert resource
consultants and educators for physicians and other health care team
members in discharge transition of care, coordination of internal
and community resources, and support the evaluation and improvement
of systems of care to support the optimal utilization of health
care resources, while maintaining quality of patient care. The
Inpatient Care Manager assumes primary accountability for
anticipating, assessing, developing, implementing, documenting,
advising, and communicating a safe discharge plan of care for
patients with complex care needs.
- Ensures review of all Kaiser Permanente patients admitted to
service area hospitals for appropriateness of admission; admission
to the appropriate level of care status; length of stay consistent
with medical and/or surgical criteria; and, ensures authorization
for hospitalization is received from non-Kaiser payer sources.
Provides timely and accurate notification to Patient Billing
Services verifying correct admit status. Facilitates care and
services for non-Kaiser patients in the hospital setting approved
by their payer source. Identifies potential delays in inpatient
care or services that may result in length of stay extensions and
communicate findings so improvement opportunities can be addressed
by involved departments. Facilitates entries in patient charts that
reflect and support definitive diagnoses and coding.
- Ensures coordination of care toward timely discharge for
routine and complex medical/surgical patients in hospital setting;
by: Independently and proactively completing assessments which are
thorough, timely, age appropriate, and reflect psychosocial support
systems, care needs, benefit array, level of care determinations,
and document same for designated population of patients. Developing
safe discharge plans by working with patients, families, and health
care teams to develop a mutually agreeable plan of care that
creatively optimizes the use of all available and appropriate
resources to support the unique and particular needs of each
patient on a case by case basis. Utilize case/family conferences
and consults to develop these care plans as needed. Implementing
care plans by ordering, brokering, and advocating for the patient
and family, while educating the patient, family, and health care
team about options and alternatives. Completing all necessary
documentation for referrals and handoffs between care settings to
ensure a seamless transition to another level of care. Acting as
Kaiser Permanente ambassador to provide member information to care
facilities (SNF, ICF, assisted living, adult foster homes,
residential care facilities) and problem-solve/facilitate any
issues which present barriers to safe transfers and the provision
of quality care, such as: special equipment needs, symptom/behavior
management, financial assessment and plan, clinical instability and
complex care needs (IV therapy, enteral feedings, wound care,
- Develops and maintains expert level of knowledge and skills
related to availability of and criteria for regulatory requirements
for utilization management and ordering of, brokering for, and
assertive advocacy for the patient and family as well as the health
care system in all matters of optimal use of health care resources.
This includes acting on behalf of the member to ensure they are
informed and understand their appeal rights and processes if they
disagree with a health care determination. Ensuring efficient
utilization of health care resources by: ensuring that the plan for
an acute care stay for individual patients is well understood by
the patient, family and health care team, and that the plan is
progressing effectively and efficiently toward resolution and
transition to a lower level of care; by assuring that
patient/family receive right care at the right time so that quality
and utilization are simultaneously enhanced.
- Provides education and program development functions,
including: Ensures systematic and ongoing contact with hospital
staff/other Kaiser departments (CCS, LTC, Expanded Care, DME, HH,
Hospice) to share information regarding care coordination role and
ongoing responsibility for acute care/ED patients. Provides and
facilitates educational support to assure health care employees
providing direct care of patients with complex discharge needs have
the knowledge and skills required to provide age and culturally
appropriate care to patients and families. Provides education to
staff regarding transition of patients across care settings.
Provides leadership in discharge planning with hospital personnel
to develop and implement policies and procedures related to patient
transfers across care settings. Ensures appropriate and timely care
to patients through collaboration with inpatient staff (RNs, CNAs,
MSWs, dieticians, therapists, respiratory therapists, inpatient
palliative care staff, pharmacists, ancillary staff), CCS and
outside resource staff. Participates in professional
committees/task forces as needed/requested. Ensures that regulatory
and compliance standards are met in collaboration with others in
the interdisciplinary healthcare team. Participates in quality and
utilization management activities. Participates in continuing
education to incorporate and maintain up to date knowledge and best
practices in leading and case managing the discharge planning
- Incorporates Principles of Responsibility into duties,
communications and interactions.
- Performs other duties as assigned.Basic
- Minimum two (2) years of acute hospital experience with
progressive levels of responsibility.Education
- BSN or bachelor's degree in a health-care related field or
currently enrolled in a BSN program, OR four (4) years hospital
case management experience.
- High School Diploma or General Education Development (GED)
required.License, Certification, Registration
- Current Oregon or Washington RN license in state where assigned
required upon hire/transfer.
- Basic Life Support (BLS) for Health Care Providers required
upon hire/transfer.Additional Requirements:
- Demonstrated ability to interrelate with physicians, nurses,
support staff, and patients in interdisciplinary approach.
- Demonstrated ability to work as part of a team and work as a
constant patient advocate.
- Basic physical, psychosocial, functional assessment
- Familiar with care processes and systems in settings internal
and external to Kaiser Permanente.
- Familiar with and able to collaborate with Kaiser Permanente
and community resources.
- Thorough knowledge of principles of teaching and delegation,
physical assessment and care planning and appropriate utilization
of acute hospital, long-term care and home care resources.
- Able to document concise yet thorough clinical documentation of
patient assessment and care needs.
- Highly effective problem solving, written and verbal
communication, organizational and time management skills.
- Familiarity with and ability to use computers.Preferred
- Minimum two (2) years of Medical/Surgical or Critical Care
- Minimum three (3) years of recent experience in one (1) or more
of the following areas: Hospital Inpatient Discharge Planning,
Community Health, Home Health and/or Utilization Management.
- Recent experience in Home Health Agency or role responsibility
for inpatient discharge planning.
- Current Certification as a Certified Case Manager (CCM) or
Accredited Case Manager (ACM)
- Demonstrates customer-focused service skills.
- Good clinical judgment to assess the needs of patients as they
relate to next level of care.
- Knowledge of the principles of patient teaching, disease
prevention measures, physical assessment and appropriate
utilization of acute hospital resources.
- Knowledge of Medicare and Medicaid regulations related to
eligibility requirements: hospital, nursing facilities, home health
and hospice eligibility requirements.
- Knowledge of Kaiser Permanente resources.
- Able to type 30 WPM with accuracy.Notes:
- -Variable working days, holiday and weekendsJob Schedule: Job
Category: Nursing Licensed & Nurse Practitioners
Keywords: Kaiser, Salem , Care Manager, Inpatient, Executive , Salem, Oregon
Didn't find what you're looking for? Search again!