Case Management Outside Utilization RN

Downey, California
Jan 30, 2024
Feb 23, 2024
Coordinates continuing care/outside services for continuing care members at one medical center. Repatriate stable Kaiser Permanente members from non-Kaiser Permanente facilities in the emergency department and admitted patients. The process involves screening for appropriateness of care and talking to the outside physician to establish stability to transfer to a Kaiser Permanente facility. Works with KFH and SCPMG staff in developing service plans, providing quality care, cost effective services that are aligned with federal, state and local regulations and continuing care business goals/objectives. Complies with other duties as described.

Essential Responsibilities:

  • Coordinates the administration and delivery of assigned outside services at one medical center.

  • Collaborates with physicians, service directors, and other health care providers to identify and implement innovative models and best practices, emphasizing service improvements and cost reduction.

  • Develops and implements quality and utilization standards to ensure coordinated plans of treatment, customer focused delivery of services and cost effective utilization of necessary services.

  • Ensures compliance with administrative, legal and regulatory requirements of the Health Plan contract and governmental regulatory and accrediting agencies.

  • Develops and enhances unit based standards as identified by regulatory agencies.

  • Provides services that meet standards for customer satisfaction with emphasis on customer service, quality and innovation.

  • Acts as liaison with non-plan providers.

  • Develops and expands relationships with contractors/providers.

  • Utilizes research data to implement service changes and improve the delivery of patient care and member outside services.

  • Identifies and recommends opportunities for cost savings and improving the quality of care and service.

  • Participates in committees, teams or other work projects/duties as assigned.

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