Case Manager RN

Kaiser Permanente - Sacramento, CA

Full-time - Entry Level

Sacramento, CA

Ambulatory Health Care Services

About the position

The Case Manager RN at Kaiser Permanente is responsible for coordinating patient care by collaborating with physicians, staff, and external providers. This role involves developing treatment plans, monitoring clinical activities, and ensuring continuity of care for members. The position requires a focus on cost-effective protocols and adherence to regulations while providing high-quality care.

Responsibilities

• Plans, develops, assesses, and evaluates care provided to members.
• Develops and maintains case management policies and procedures.
• Coordinates, directs, and performs concurrent and retrospective reviews, and monitors level and quality of care.
• Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
• Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization.
• Coordinates repatriation of patients and monitors their quality of care.
• Arranges and monitors follow-up appointments and encourages members to follow prescribed courses of care.
• Makes referrals to appropriate community services.
• Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
• Develops and collects data, and trends utilization of health care resources.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Acts as liaison for outside agencies, non-plan facilities, and outside providers.

Requirements

• Graduate of an accredited school of nursing.
• 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.
• Registered Nurse License (California)
• Knowledge of Nurse Practice Act, The Joint Commission and other federal/state/local regulations.
• Must be able to work in a Labor/Management Partnership environment.

Nice-to-haves

• Minimum six (6) months of previous case management experience preferred.
• Experience in utilization management, discharge planning, or transfer coordination.
• PHN preferred.
• Masters degree preferred.

Benefits

• Health insurance coverage
• Dental insurance coverage
• Vision insurance coverage
• 401k retirement savings plan
• Paid holidays
• Paid time off (PTO)
• Flexible scheduling options