JOB SUMMARY:

Facilitates services related to coordination of care by coordinating case management to include continuity of care, inpatient and outpatient care, utilization management, transfer coordination, discharge planning, travel and lodging needs, patient and family education specific to transplant related care, and in-patient concurrent review, and sharing professional knowledge with the broader team; implementing policy updates to ensure that a comprehensive system for care is in place where patients are appropriately managed through the continuum of care, resources both internally and externally are appropriately utilized, and successful outcomes are achieved; identifying barriers to care and selecting appropriate solutions from potential options for intervention, based on a set of complex and individual patient needs, including identifying cultural, linguistic, and age-related needs and incorporating actions to address such needs in the case management plan, and guiding team members to do the same; developing plans of care relative to patient goal identification and needs for achievement, as well as resources required to meet the needs of the patient independently; and triaging patient and provider calls both internally and from transplant centers when performing on-call responsibilities. Helps maintain relationships with programs of excellence by collaborating independently with programs of excellence (POE) with the goal of providing total quality and case management for Kaiser Permanente (KP) members receiving transplant services; reviewing information forwarded to POEs, and requesting additional clinical information from POEs; and requesting communication of authorizations to the referring provider, POE, member, and/or claims unit. Contributes to improvements to operations by identifying and reporting quality of care issues, trends, and events as well as other information on the key elements of the quality program occurring both internally and within POEs that relate to the delivery of care to transplant patients; implementing systems to ensure that referrals for transplant services occur within POEs; and implementing policy updates to ensure performance improvement initiatives. Supports efforts to remain updated on current research, policies, and procedures by managing the teams current knowledge in the field of transplantation and integrating this knowledge into the assessment of needs and problem solving required to manage across the continuum; updating education shared with members, families, physicians, POEs, and local providers regarding transplant services; and attending educational event and share with peers. Supports compliance efforts by proactively maintaining the privacy and confidentiality of information; protecting the assets of the organization; acting with ethics and integrity; reporting non compliance; and adhering to applicable federal/state/local laws and regulations, accreditation, and licensure requirements, and KP policies and procedures; and working within the scope of nursing practice and organization policies in the management of caseload assigned independently. Facilitating billing initiatives by consulting with various departments on transplant claims questions by providing clinical insight under minimal guidance.

MINIMUM QUALIFICATIONS:

• Bachelors degree in Nursing AND minimum five (5) years of experience in case management, transplant, acute care, or a directly related field.
• Registered Nurse License (California) required at hire

ADDITIONAL REQUIREMENTS:

• Knowledge, Skills, and Abilities (KSAs): Information Gathering; Cost Optimization; Written Communication; Confidentiality; Maintain Files and Records; Business Relationship Management; Company Representation; Managing Diverse Relationships; Relationship Building; Member Service; Patient Safety; Microsoft Office; Quality Assurance and Effectiveness
  PrimaryLocation : California,Los Angeles,4733 Sunset Annex
  HoursPerWeek : 40
  Shift : Day
  Workdays : Mon, Tue, Wed, Thu, Fri
  WorkingHoursStart : 08:00 AM
  WorkingHoursEnd : 04:30 PM
  Job Schedule : Full-time
  Job Type : Standard
  Employee Status : Regular
  Employee Group/Union Affiliation : NUE-PO-01|NUE|Non Union Employee
  Job Level : Individual Contributor
  Job Category : Nursing & Care Delivery
  Department : Po/Ho Corp - National Transplant Services - 0308
  Travel : No
  Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Facilitating billing initiatives by: consulting with various departments on transplant claims questions by providing clinical insight under minimal guidance.
• Helps maintain relationships with programs of excellence by: collaborating independently with programs of excellence (POE) with the goal of providing total quality and case management for Kaiser Permanente (KP) members receiving transplant services; reviewing information forwarded to POEs, and requesting additional clinical information from POEs; and requesting communication of authorizations to the referring provider, POE, member, and/or claims unit.
• Supports compliance efforts by: proactively maintaining the privacy and confidentiality of information; protecting the assets of the organization; acting with ethics and integrity; reporting non compliance; and adhering to applicable federal/state/local laws and regulations, accreditation, and licensure requirements, and KP policies and procedures; and working within the scope of nursing practice and organization policies in the management of caseload assigned independently.
• Supports efforts to remain updated on current research, policies, and procedures by: managing the teams current knowledge in the field of transplantation and integrating this knowledge into the assessment of needs and problem solving required to manage across the continuum; updating education shared with members, families, physicians, POEs, and local providers regarding transplant services; and attending educational event and share with peers.
• Facilitating contract alignment by: ensuring contracts (e.g., within network or single case agreement) are established for Transplant services; leveraging knowledge of the terms of the contract to administer the terms as written; partnering with National Contracting Services to coordinate transplant logistics.
• Facilitates services related to coordination of care by: coordinating case management to include continuity of care, inpatient and outpatient care, utilization management, transfer coordination, discharge planning, travel and lodging needs, patient and family education specific to transplant related care, and in-patient concurrent review, and sharing professional knowledge with the broader team; implementing policy updates to ensure that a comprehensive system for care is in place where patients are appropriately managed through the continuum of care, resources both internally and externally are appropriately utilized, and successful outcomes are achieved; identifying barriers to care and selecting appropriate solutions from potential options for intervention, based on a set of complex and individual patient needs, including identifying cultural, linguistic, and age-related needs and incorporating actions to address such needs in the case management plan, and guiding team members to do the same; developing plans of care relative to patient goal identification and needs for achievement, as well as resources required to meet the needs of the patient independently; providing pre-transplant and post-transplant care; coordinating and assisting with pre-surgery/transplant evaluation processes; facilitating services required to obtain approval for procedures as defined in policies/procedures and clinical algorithms; facilitating direct admissions of patients; coordinating the initial follow-up appointment with the surgery/transplant center or primary care facility; coordinating treatments for patients including those experiencing complications; coordinating the referral process as defined for area of care, confirming potential transplant/surgical candidates after they have been identified; ensuring that all testing related to transplant listing is completed within KP facilities and communicated to the Transplant program (lab testing, clinical updates, status changes, insurance authorization status, travel arrangement, coordinate outside testing); leveraging advanced knowledge to support supporting patients/family/significant others in problem solving and/or in coping with lifestyle changes; and triaging patient and provider calls both internally and from transplant centers when performing on-call responsibilities.
• Contributes to improvements to operations by: identifying and reporting quality of care issues, trends, and events as well as other information on the key elements of the quality program occurring both internally and within POEs that relate to the delivery of care to transplant patients; implementing systems to ensure that referrals for transplant services occur within POEs; and implementing policy updates to ensure performance improvement initiatives.