Liaison Nurse - Nursing Home Services 1.0 FTE Lacey/Olympia

About the role

The Liaison Nurse works in a patient‑interfacing case management capacity across two Kaiser Foundation Health Plan of Washington (KFHPW) facilities (Olympia Woodard Creek and Lacey Post‑Acute). The role rotates between onsite (four days) and remote (one day) work, planning discharges and follow‑up care for KFHPW patients hospitalized at a nearby network facility and managing a caseload of patients at a KFHPW medical center. The nurse collaborates with primary and specialty care teams, serves as a liaison across the internal KFHPW care continuum and external providers, and provides data and feedback on utilization, cost, quality, and service delivery.

Essential Responsibilities

• Ensure patients referred to case management meet established criteria.
• Assess all referred patients to determine physical, mental, financial, and psychosocial status using comprehensive, standardized criteria.
• Develop patient‑centered case management plans that include goals, objectives, outcomes, and time frames.
• Evaluate the ability and availability of designated caregivers to provide patient support.
• Coordinate and implement interventions using evidence‑based guidelines.
• Recommend additional services to primary care providers as determined in the case management plan.
• Conduct ongoing assessment of progress against original goals and continuously update needed services.
• Maintain ongoing communication with patients, families, and the care team; act as an advocate for patient care needs.
• Document all patient responses to case management interventions.
• Collaborate with other health‑care professionals regarding the plan of care, variances in implementation, and outcomes.
• Monitor and evaluate short‑ and long‑term patient responses to therapeutic interventions and analyze patterns of variance.
• Recommend alternative care settings based on health‑care needs and appropriate resource utilization.
• Document interventions and interactions according to KFHPW and Care Management policies.
• Participate in measuring the effectiveness of the case management program.
• Guide the plan of care to ensure a seamless continuum of care.
• Facilitate referrals for home health, long‑term care, hospice, and other services as needed.
• Participate on a limited basis in care conferences for complex cases.
• Collect data to evaluate the effects of care coordination on quality outcomes, fiscal parameters, patient satisfaction, and system improvement.
• Understand and apply health‑plan requirements and patient benefits in care‑management decisions.
• Assist patients in understanding and complying with their medical treatment plans.
• Support patient education and activation through referrals to chronic‑illness classes, group visits, or community resources.

Basic Qualifications

• Minimum three (3) years of recent RN medical/surgical/ambulatory clinical experience.
• Minimum two (2) years of RN experience in ambulatory case management, care coordination, or disease management.
• Bachelor’s degree.
• Registered Nurse license (Washington) required at hire, or a compact RN license.
• Basic Life Support certification required at hire.
• Case Manager Certificate to be obtained within 36 months of hire.

Preferred Qualifications

• Minimum two (2) years of RN experience in utilization review, ambulatory case management, care coordination, or disease management.
• Bachelor of Science in Nursing.

Skills and Competencies

• Effective, independent nursing judgment and evidence‑based clinical decision‑making.
• Knowledge of chronic disease management, nursing process, and collaborative care planning.
• Demonstrated ability to collaborate effectively with multidisciplinary care team members.

Pay

Pay range: $48.57 – $81.90 per hour (base salary determined by market data, internal alignment, experience, education, certifications, skills, and geographic location).

Schedule

Full‑time, 40 weekly hours. Day shift, Monday – Friday, 08:00 AM – 04:30 PM. Some weekends and holidays required; scheduled days may vary. Work setting is flexible with no travel required.