Provides case management and outreach services to selected patients. Provides discharge planning services and assists with follow-up for Health Plan members hospitalized at community hospitals. Incorporates Risk Management, Quality Management and Utilization Management concepts into daily hospital and clinic activities.
Essential
Implements Continuing Care programs and initiatives with Continuing Care providers and PCP Team. Assists with integrating programs and initiatives into daily practice. Makes clinic/location-specific adaptations as necessary to insure successful implementation of model.
Monitors and evaluates outcomes. Provides case management services to targeted patients/families by interviewing and evaluating their needs. Develops work plans to assist patients/families in meeting identified needs.
Coordinates resources and services to assure continuity and quality of care. Maintains working knowledge of community resources. Interprets Kaiser Permanente benefits/services to patients, families, and members of community.
Monitors high-risk members and assists them with access to care. Integrates patients into existing programs/services. Evaluates outcomes and makes recommendations for change.
Assists patients/families with identified problems/concerns. Meets with Continuing Care providers and PCP Team to monitor targeted patients. Assists Team by coordinating community care.
Explores options to assure that quality, cost-efficient care is provided. Makes daily hospital rounds for early identification of UM and discharge planning activities. Assists physician/patient/family in planning discharge. to facilitate smooth transfer to home or alternate facility.
Reports any Risk/Quality/Utilization Management issues to Neighbor Island Management Team. Acts as contact person for MOA/Oahu discharges. Assists patients with smooth transfer to home.
Participates in community hospital interdisciplinary team meetings. Maintains confidentiality of all patient information. May perform patient care to the extent necessary to maintain clinical expertise, competency and licensing necessary to fulfill job responsibilities and to direct the provision of care on the unit.
Develops and maintains collegial and consultative working relationship with Government Programs office staff to assure that all regulatory requirements are met and necessary changes are implemented. Attends community seminars and workshops specific to professional needs. Participates in approved educational programs.
Assists in developing, implementing, maintaining, evaluating, and enhancing Total Quality Management activities within organization. Makes suggestions for change/improvement as indicated. Incorporates the KP Nursing Vision, Model and Values through out their Nursing Practice.
Qualifications
Experience Minimum one (1) year of working with low income/high risk patients, preferably in healthcare setting, including experience or successful completion of training program (pre-hire, post-hire, or on-the-job) in area of specialty, if applicable. Education Bachelors degree in nursing OR four (4) years of experience in a directly related field. License, Certification, Registration Registered Nurse License (Hawaii) required at hire Basic Life Support from American Heart Association Additional
Case management/community outreach experience. Demonstrated knowledge of and skill in oral communication, written communication, interpersonal relations, customer service, change management, multi-task and problem solving. Demonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.
Program development and operations level implementation. Geriatric experience in outpatient clinic setting. Supervisory/lead experience.
Scheduled Weekly Hours: 32
Day Workdays: Sun, Mon, Tue, Wed, Thu, Fri, Sat Working Hours Start: 12:01 AM Working Hours End: 11:59 PM Job
Part-time Job Type: Standard Employee Status: Regular Worker Location: Flexible Employee Group/Union Affiliation: NUE-HI-01|NUE|Non Union Employee Job Level: Individual Contributor Department: Maui Lani Medical Offices - Utilization Management - 1208
$97200 - $125752 / year Travel: No