Case Manager ED, Kona/Hilo

Location
Kailua Kona, Hawaii
Posted
May 08, 2024
Closes
Jul 19, 2024
Ref
60208152288
Specialty
Other
Job Summary:

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 Responsibilities:


  • 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.