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Care Manager, Inpatient

Company: Kaiser
Location: Salem
Posted on: November 25, 2022

Job Description:

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.
Essential Responsibilities:

  • 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, therapy needs).
  • 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 process.
  • Incorporates Principles of Responsibility into duties, communications and interactions.
  • Performs other duties as assigned.Basic Qualifications:Experience
  • 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 skills.
        • 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 Qualifications:
          • Minimum two (2) years of Medical/Surgical or Critical Care Nursing.
          • 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.
          • MSN.
          • 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

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