Patient Care Coordinator, RN

About the role

At Kaiser Permanente, Patient Care Coordinators, RN, play a crucial role in optimizing the total health of our members and the communities we serve. They utilize scientific evidence and our integrated care model to support the patient directly in our hospitals or clinics, providing care at home, and managing care delivery teams.

Responsibilities

• Utilizes established criteria, to perform daily inpatient review activities, including prospective, concurrent, and retrospective utilization review for all members requiring inpatient admission.
• Performs an admission utilization review upon admission.
• Affords discharge planning needs and documents assessment using designated tools in EMR for all new inpatient admissions within 24 hours and begins the discharge planning process immediately.
• Conducts a concurrent utilization review of all patients daily and as appropriate based on criteria and policy.
• Assesses daily all patients for post-hospital care planning and coordinates discharge plans, ensuring appropriate level of care in the most suitable setting.
• Performs daily bedside rounds on patients and/or significant other to update on discharge planning.
• Reviews charts daily to ensure progression of plan of care and to prepare for daily discharge planning needs.
• Escalates barriers to discharge in real time after usual processes cannot affect discharge.
• Leverages written escalation pathways to ensure timely care and timely discharge for patients.
• Establishes and evolves a discharge plan in parallel with the medical plan to ensure patients discharge plan is ready at the same time as medical clearance.
• Performs and documents a social screening assessment for all patients admitted to hospital and places referrals to internal programs and social workers as appropriate.
• Prepares for and attends all scheduled rounds with physician partners and leaders to discuss clinical courses, discharge planning, barriers to care / discharge and quality concerns.
• Communicates regularly with hospitalist partners and other healthcare team members to monitor patient progress and address delays or quality issues.
• Establishes and maintains contact with patients and their families as appropriate, including the provision of education when needed and planning for discharge along the hospital stay.
• Arranges follow up appointments for medical and surgical patients who are discharged home as needed.
• Ensures that the appropriate level of care is being delivered in the most appropriate setting.
• Performs quality of care and service reviews using identified quality indicators.
• Performs readmission reviews and identifies plan of care for discharge to prevent future readmissions.
• Sends appropriate referrals for post-acute needs.
• Secures post-acute services for discharging patients in advance of medical clearance.
• Remains knowledgeable of contract benefits and current, relevant state and Federal regulations, criteria, documentation requirements and laws that affect managed care and case/utilization management.
• Maintains effective interaction/communication with members of the medical staff, nursing staff, complex case managers, home care review team, social workers, general reviewers, referral coordinators, and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care.
• Builds effective working relationships with physicians, department staff, post-acute staff, vendors, and other departments within the health plan.
• Aids in the development and revision of guidelines, pathways and protocols.
• Coordination of case conferences for complex cases and facilitates transfers to appropriate facilities.
• Documents a daily progress note in EMR with evolving discharge plan.
• Refers cases identified as risk or quality issues to the appropriate department for review using the appropriate reporting tool.

Requirements

• Minimum two (2) years of RN experience in utilization/case management, discharge planning, quality improvement, or patient care delivery in a healthcare setting.
• Bachelor's Degree in Nursing or four (4) years of experience in a directly related field.
• Registered Professional Nurse License (Georgia).

Qualifications

• Functional knowledge of computers and experience with managed health care delivery, including Medicare.
• Advanced communication and interpersonal skills with all levels of internal and external customers.
• Ability to collaborate effectively with multidisciplinary healthcare teams.
• Excellent time management skills; ability to work in a fast-paced environment.

Skills

• Collaborative
• Compassionate
• Flexible
• Leadership
• Socially Conscientious
• Trustworthy

Benefits

We offer several benefits to our nurses, including:

• Opportunities for lifelong learning and professional growth.
• An environment of compassion, integrity, trust, and open communication.
• Competitive compensation and comprehensive benefits package.

Pay

The pay for this position is competitive and commensurate with experience.

Schedule

The job schedule is Full-time with Scheduled Weekly Hours: Not specified. Shift: Day.

Notes

• Working primarily managing claims and appeals.
• Mon thru Fri with rotating weekends and holidays.