Case Manager Specialty RN

$126,443 - $154,752/Yr

Kaiser Permanente - Bakersfield, CA

Full-time - Mid Level

Bakersfield, CA

10,001+ employees

Ambulatory Health Care Services

About the position

The Case Manager Specialty RN works collaboratively with a panel of physicians to manage the specialized needs of patients with chronic diseases. This role involves assessing patient needs, developing care management plans, coordinating access to health services, and promoting self-care management. The Case Manager acts as a clinical liaison, patient advocate, and educator, ensuring continuity of care and compliance with regulations.

Responsibilities

• Evaluates and identifies members' needs.
• Interfaces with Primary Care Physicians, Specialists, and various disciplines on the development of case management plans/programs.
• Monitors and evaluates the effectiveness of the case management plans and modifies as necessary.
• Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
• Acts as a clinical liaison with outside agencies such as County CCS, non-plan facilities, outside providers, employers, and/or workers compensation carriers and third-party administrators.
• Prepares reports, communicates program changes to appropriate staff, and develops protocols in accordance with state regulations.
• Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and is empowered to participate in the plan of care.
• Develops individualized patient/family education plans focused on self-management and delivers education specific to a disease state.
• Develops and updates training and educational materials and presents them to appropriate staff, members, and families.
• Facilitates patients' return to normal daily activities by teaching and making appropriate referrals for outside services/continued care.
• Consults with internal and external physicians, health care providers, discharge planners, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
• Coordinates transmission of clinical and benefit treatment to patients, families, and outside agencies.
• Participates in data collection and analysis of clinical outcomes of care and customer satisfaction standards.
• Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service.
• Ensures that accurate records are maintained of the care associated with each patient.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.

Requirements

• Minimum two (2) years clinical experience as an RN in an acute care or ambulatory care setting required.
• Bachelor's degree or equivalent experience (four (4) years) required.
• Registered Nurse License (California) required.
• Basic Life Support certification required.
• Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques, and methods of utilization review/management, care coordination, transfer coordination, discharge planning, or case management.
• Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
• Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking, and problem-solving skills required.
• Computer literacy skills required.