Job 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. COMPANY: KAISER TITLE: Regional Telephonic Case Manager RN LOCATION: Pleasanton, California REQNUMBER: 1350976 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.

Job Tags

Hourly pay, Contract work, Work at office, Local area,

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