Regional Telephonic Case Manager RN

Description: Job Summary:

Coordinates w/physicians, staff, facilities, non-Kaiser providers, insurers, 3rd party administrators, & employers regarding patient care. In conjunction w/physicians, develops treatment plan, monitors all clinical activities, makes recommendations for alternative levels of care, identifies cost effective protocols, & develops guidelines for care..

Essential Responsibilities:

• Guides, facilitates & expedites the care & maximum recovery for employees with work related illnesses or injuries through telephone and electronic communication with patients, carriers, employers, providers (internal & external), & Kaiser Permanente staff. Coordinates patient education & monitors & evaluates the options & services necessary to meet the individual patients needs.
• Facilitates and assists physicians and disability case managers in return to work duties.
• Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, & facilitates authorizations and approvals as needed for outside services for patients/families.
• Educates & informs patient & family regarding treatment plan & facilitates return to wellness. Evaluates variance from treatment guidelines caused and takes remedial actions. Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy). Makes referrals to appropriate community services.
• Identifies & recommends opportunities for cost savings & improving the quality of care across the continuum.
• Develops & collects data, & trends relating to utilization of health care resources. Interprets regulations, health plan benefits, policies, & procedures for members, physicians, medical office staff,contract providers, and outside agencies.
• Coordinates transmission of clinical & benefit treatment to patients, families & outside agencies. Acts as liaison for outside agencies, nonplan facilities, & outside providers.
• Coordinates repatriation of patients & monitors their quality of care.
• Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.

Basic Qualifications:

Experience

• Minimum of two (2) years working within an occupational health/industrial environment.
• Minimum of four (4) years of ongoing experience evaluating patients & work processes from a variety of industries.

Education

• Bachelors degree in nursing or health related field, OR four (4) years of experience in a directly related field.
• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• Registered Nurse License (California)

Additional Requirements:

• Certified Occupational Health Nurse or Certified Case Manager certification required (or fulfilled within two (2) years of hire).
• Knowledge of current California Workers Compensation system & laws.
• Demonstrated experience in utilization management, return to work planning &/or case management.
• Knowledge of Nurse Practice Act.
• Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

• Previous case management experience preferred.
• Masters degree preferred.
• Preference for Certified Case Manager credential.
• Must have California workers' compensation experience/knowledge.

Notes:

The position is for an RN.

Preference for Certified Case Manager credential. Must obtain the CCM credential within 2 years of hire.

Primary Location: California,Pleasanton,Pleasanton Tech Cntr Building E
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri,
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NCAL-09|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Oakland Reg - 1950 Franklin - TQM-Occup Health Initivs - 0206
Pay Range: $74.51 - $96.4 / hour Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status. Submit Interest