About Job
- Performs as an organizational liaison between Health Plan, MAPMG providers and faculty and staff at facility.
- Promotes relationships and communication between KP members, Health Plan, MAPMG providers and faculty and
- staff at facility.
- Develops collaborative relationships within MAPMG, facility faculty and staff and other KP departments to provide and facilitate transitions of care.
- Manages and directs Patient Care Coordinators and support staff to ensure utilization management and discharge planning activities are applied in a consistent and effective manner. Oversees day to day activities of assigned staff, to include staff scheduling, caseload assignment, appropriate utilization of resources and timely discharge planning.
- Ensures member benefits are interpreted and applied correctly and in compliance with state and federal regulations.
- Conducts case level reviews and provides feedback to Patient Care Coordinator staff on a regular basis.
- Participates in multidisciplinary rounds. Ensures that transitions of care to alternative levels of care are smooth and
- coordinated with Health Plan, facility, providers and KP member/family.
- Provides support and oversight of UM activities (i.e., use of UM guidelines / criteria and UM processes).
- Partners with other members of the UMOC and Continuing Care teams to develop and implement collaborative
- processes.
- Supports professional growth by providing education, training and appropriate resources.Conducts performance
- evaluations, provides coaching and acts as a mentor to direct reports.
- • Performs other related duties as assigned.
- Minimum of five (5) years of experience in a clinical setting.
- Minimum of two (2) of the five (5) years of experience as a Registered Nurse OR in Utilization Management OR Case Management.
- Minimum of two (2) of the five (5) years of supervisory OR as a Kaiser Permanente Patient Care Coordinator experience.
- Bachelors degree in nursing, health care administration or related field.
- This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire.
- Registered Nurse License (Virginia) within 6 months of hire AND Registered Nurse License (Maryland) within 6 months of hire
- Compact License: Registered Nurse within 6 months of hire
- Registered Nurse License (District of Columbia) within 6 months of hire
- Basic Life Support from American Heart Association
- Proficient in computer applications including Microsoft Word, PowerPoint and Excel required.
- Strong interpersonal skills, with good verbal and written communication skills required.
- Skills in problem-solving and collaboration with other professions/ disciplines required.
- Ability to work comfortably and effectively in a hospital and managed care setting required.
- Experience working with various member populations in a community setting.
- Working knowledge of KP or experience working with state Medicaid/Medicare plans.
- Masters degree in nursing, health care administration or related field.
- Certification in Case Management from Commission for Case Manager Certification or Nursing Case Manager Certification from American Nurses Credentialing Center.
- Knowledge of KP or other integrated health care delivery system.
- Managerial experience in Case Management and Utilization Management preferred
- Will have oversight over AAMC and BWMC.
- Will backfill colleagues on vacation.
- Role requires Weekend and holiday coverage
- Online Submissions
- Pre-Hire Assessments
- Interview Process
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