Kaiser Permanente Coordinator Patient Care Lead-Continuing Care in Honolulu, Hawaii

Serves as lead for Utilization Management (UM) of Continuing Care. Assists UM Manager with the management of the department, and assists in developing, implementing and maintaining utilization management policies and procedures. Trains, monitors, and counsels assigned staff. 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. Analyzes data relevant to the utilization of healthcare resources. Participates in the development, implementation, communication, maintenance and monitoring of local UM Workplan initiatives.

Essential Functions:

  • Performs daily pre-admission, admission, & concurrent utilization reviews to determine appropriate levels of care & readiness for discharge. Escalates utilization & system problems which have not been resolved immediately. Performs rounds & reviews patient admissions under Kaiser Skilled Nursing Facility (SNF) benefit. Utilizes knowledge & experience of Medicare regulations & Health Plan benefits to determine medical necessity. Monitors the progression of the plan of care & facilitates discussions w/ the multidisciplinary teams. Educates other healthcare team members on utilization & cost containment initiatives. Collaborates w/ & provides information to patients, families, physicians, & staff regarding the provisions of care. Issues denial/notices of non-coverage letters after conferring w/ physicians.

  • Ensures continuity of care for outside services for the patient. Monitors level of care. Develops, evaluates, & coordinates a comprehensive discharge plan in conjunction w/ the patient/family, physician, nursing, social services, & other healthcare providers & agencies.

  • Monitors care processes & participates in the development & implementation of guidelines, pre-printed physician orders, care paths, etc. for patient care. Identifies & assists in the implementation of opportunities for cost-savings & improvements in the quality of care across the continuum. Establishes & maintains effective relationships between Kaiser Permanente & the community facilities. Identifies quality improvement & relationship building opportunities. Monitors high-cost cases & reports findings to Hospital Administration, Director of Continuing Care and/or Community Medical Services. Keeps abreast of current changes in health care benefits, laws or regulatory requirements which influence health plan benefit issues.

  • Develops, collects, trends, & analyzes data relevant to the utilization of healthcare resources. Participates in the development, implementation, communication, maintenance & monitoring of local UM Workplan initiatives.

  • Serves as lead for Utilization Mgmt (UM) of Continuing Care. Shares accountability w/ the UM Manager for planning, developing, & managing the department budget. Trains, monitors, & counsels assigned staff. Recommends & provides input for performance evaluation, hiring, disciplining & termination of assigned staff as appropriate. Reports problems to supervisor, & assists in resolution. May plan & control work assignments & special projects of team members. Assists in developing, implementing & maintaining utilization mgmt policies & procedures.

  • May perform patient care to the extent necessary to maintain clinical expertise, competency, & licensing necessary to fulfill job responsibilities & to direct the provision of care on the unit.

  • This job description is not all encompassing.

Basic Qualifications:

Experience

  • Minimum two (2) years of experience in utilization review, case management, and discharge planning.

Education

  • Bachelor's degree in nursing; or four (4) years of directly related experience.

License, Certification, Registration

  • Valid Hawaii RN license (must meet education requirement(s) for Hawaii State licensure).

  • Current BLS for Healthcare Provider CPR or CPR/AED for the Professional Rescuer certification.

Additional Requirements:

  • Demonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.

  • Analytical and interpretive ability of data in daily operations.

Preferred Qualifications:

  • Case management experience

  • Supervisory/lead or project management experience.

  • Master's Degree in health care administration, nursing, or related field.

COMPANY: KAISER

TITLE: Coordinator Patient Care Lead-Continuing Care

LOCATION: Honolulu, Hawaii

REQNUMBER: 689893

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.