Case Manager OS Utilization RN

About This Role

Coordinates continuing care for members at a medical center, including repatriating stable Kaiser Permanente members from non-Kaiser Permanente facilities. This role involves screening appropriate care, communicating with outside physicians, and developing service plans to ensure quality, cost-effective services. Also responsible for ensuring compliance with regulations and enhancing unit-based standards.

Responsibilities

• Coordinates the administration and delivery of assigned outside services at one medical center
• Collaborates with physicians, service directors, and other health care providers to identify and implement innovative models and best practices, emphasizing service improvements and cost reduction
• Develops and implements quality and utilization standards to ensure coordinated plans of treatment, customer focused delivery of services and cost effective utilization of necessary services
• Ensures compliance with administrative, legal and regulatory requirements of the Health Plan contract and governmental regulatory and accrediting agencies
• Develops and enhances unit based standards as identified by regulatory agencies
• Provides services that meet standards for customer satisfaction with emphasis on customer service, quality and innovation
• Acts as liaison with non-plan providers
• Develops and expands relationships with contractors/providers
• Utilizes research data to implement service changes and improve the delivery of patient care and member outside services
• Identifies and recommends opportunities for cost savings and improving the quality of care and service