Nurse Case Manager II, Genetics at Kaiser Permanente

Oakland, California, United States -

Full Time

Start Date

Immediate

Expiry Date

20 Jul, 26

Salary

0.0

Posted On

21 Apr, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Case management, Clinical nursing, Genetics, Patient assessment, Care planning, Utilization management, Interdisciplinary collaboration, Regulatory compliance, Quality monitoring, Patient education, Risk management, Disposition planning, Medical necessity assessment, Documentation, Program development

Industry

Medical Practices

Description

Job Summary: In addition to the responsibilities listed below, this position is also responsible for providing advanced clinical nursing expertise and case management services for patients with, or at risk for, genetic/congenital conditions to ensure quality of care using an interdisciplinary approach; educating and collaborating with patients, families/caregivers, community resources, and medical staff/providers to assess the needs of patients with, or at risk of, genetic/congenital conditions; providing on-going program planning and management for patients with, or at risk for, genetic/congenital conditions; contributing expertise to complex analysis of patient and program information from various data sources to inform program development, risk management, and quality monitoring; identifying and implementing enhanced clinical practice standards and protocols for the genetics department and region, leveraging a broad scope of nursing expertise and knowledge of current genetics research; and supporting genetics department compliance with relevant Kaiser regulatory requirements. Essential Responsibilities: 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. Drives services related to the initial case assessment by: interviewing patients and their families to evaluate needs, goals, and current services independently; identifying and proposing process improvements for determining initial eligibility, benefits, and education for all admissions; analyzing and ensuring authorization data (e.g., authorization data regarding admitting/principle diagnoses, bed type(s), and disposition data for accuracy, after visit summary) and correcting and escalating inaccuracies; recommending and designing research plans that identify new and/or existing options to assure that quality, cost-efficient care is provided; and leveraging advanced knowledge to assess medical necessity for hospital admission and required level of care to inform physicians. Provides services related to monitoring and evaluating plan of care by: coordinating resources and services to assure continuity and quality of care, sharing advanced knowledge with others, and developing strategies; updating authorizations, attending case management rounds with clinicians, and updating diagnoses as needed; contacting own patients periodically to assess progress toward treatment milestones and care plan goals, and beginning to coordinate team members to do the same; identifying barriers to achieving goals and ensuring that they are discussed with the patient and care team thoroughly, and guiding team members doing the same; promoting best practices for verifying that all services remain consistent with established guidelines and standards; and documenting/updating the patients case in all medical files while sharing standards with the team. Drives services related to the case-planning process by: creating a client-focused case management plan with treatment goals based on the patients and familys/caregivers needs independently; collaborating independently with health-care team, patient, and caregivers to assure plan of care is safe, agreeable, and appropriate; and validating that the plan is consistent with regulatory, accreditation, and regional guidelines independently, and sharing feedback with team members as needed. Supports efforts to remain updated on current research, policies, and procedures by: researching, recommending, and attending pertinent seminars, workshops, and approved educational programs and workshops specific to professional needs; implementing systems, processes, and methods to maintain team knowledge of community resources; monitoring and/or reviewing operational team data and key metrics applied to own work; making suggestions for change or improvement as needed, and helping others to develop ideas as needed; and implementing policy updates to ensure that regulatory requirements are being met. Provides services related to patient disposition by: performing daily review for early identification of disposition planning activities; developing, evaluating, coordinating, and communicating a comprehensive disposition plan in collaboration with the patient, family, physician, nurses, social services, and other healthcare providers and agencies to meet each patients personal, psychosocial, economic, and cultural needs independently; and leveraging advanced knowledge to create, obtain, and approve authorizations/approvals as needed for services for the patient. Connects patients with existing services by: guiding others to assist patients with gaining access to care based on their needs, integrating or referring them into existing programs/services, and resolving moderately complex issues; referring patients independently to outside entities, ambulatory case managers, care managers, social workers, and/or internal/external resources as appropriate; utilization management for internal case management post acute care services; hospital level of care, post-acute care, skilled nursing facility (SNF), and durable medical equipment (DME), and transition and complex case management and making location-specific adaptations as necessary. Serves as liaison between internal and external care by: reviewing benefits/services available based on regulations or specific coverage to patients, families, and other members of the community, problem solving identified concerns, and connecting patients/families with the right entities to assist with benefits/coverage needs; providing case management to a caseload of low- and medium-risk patients referred to external facilities/agencies independently; applying strategies and concepts to independently propose recommendations in interdisciplinary team meetings with internal and/or external stakeholders; and leveraging advanced knowledge to act as a general resource for physicians, health plan administrators, and contracted vendors. Minimum Qualifications: Masters degree in Nursing, Public Health, Health Education or related field AND minimum three (3) years of experience in nursing, case management, or a directly related field. Registered Nurse License (California) required at hire

Responsibilities

The Nurse Case Manager provides advanced clinical nursing expertise and case management for patients with genetic conditions using an interdisciplinary approach. They are responsible for program planning, quality monitoring, and coordinating care plans to ensure cost-efficient and high-quality patient outcomes.