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Experience:
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Employment Type:
Intern/Co-op
Posted:
5/20/2015
Job Category:
Health Care Provider
Industry:
Health Care & Medicine
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Patient Care Coordinator RN - Utilization Management, Baltimore Service Area
Kaiser Permanente | Rockville, Maryland
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Job Description

The Patient Care Coordinator is responsible for utilization review, discharge planning and transitions in care, in collaboration with MAPMG rounder in acute or alternative settings of care.

Essential Functions:
Utilization Review. According to department policy, procedure and protocols, consistently apply and verbally communicate approved utilization review criteria and guidelines for services delivered in acute or alternative care settings.
Eligibility and Benefit Verification. Confirm eligibility status and ensure the appropriate administration of benefits in accordance with department policies and procedures.
Assessing Right Venue of Care with Hospitalist. Collaboration with Hospitalist to assess the appropriate level of care for patients (i.e., Medical Unit, Surgical Unit, Tele Unit, TCU, ICU) and post- (Home, Continuum or Community-based Services) hospitalization.
Coordination of Care. Driving patient care plan through assuring daily plan is executed, and management of transitions and post-hospital care.
Effective Discharge Planning. Prompt, clinically appropriate discharge planning beginning at time of admission.
Variance Management. Timely steps in identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions.
Quality Screening. Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards.
Performs other related duties as directed.
The Patient Care Coordinator is responsible for utilization review, discharge planning and transitions in care, in collaboration with MAPMG rounder in acute or alternative settings of care.

Essential Functions:
Utilization Review. According to department policy, procedure and protocols, consistently apply and verbally communicate approved utilization review criteria and guidelines for services delivered in acute or alternative care settings.
Eligibility and Benefit Verification. Confirm eligibility status and ensure the appropriate administration of benefits in accordance with department policies and procedures.
Assessing Right Venue of Care with Hospitalist. Collaboration with Hospitalist to assess the appropriate level of care for patients (i.e., Medical Unit, Surgical Unit, Tele Unit, TCU, ICU) and post- (Home, Continuum or Community-based Services) hospitalization.
Coordination of Care. Driving patient care plan through assuring daily plan is executed, and management of transitions and post-hospital care.
Effective Discharge Planning. Prompt, clinically appropriate discharge planning beginning at time of admission.
Variance Management. Timely steps in identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions.
Quality Screening. Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards.
Performs other related duties as directed.

Qualifications

Basic Qualifications:
Experience
Two (2) years of experience in acute hospital utilization review or equivalent required.
Education
N/A
License, Certification, Registration
RN License in jurisdiction where assigned required
BLS certification required.

Additional Requirements:
New Hire: Successful completion of PCC Orientation and Assessment of Critical Skills. Passing score on inter-rater reliability.
Annually: Successful completion of PCC Assessment of Critical Skills. Passing score on inter-rater reliability.
Ability to effectively communicate.
Ability to conform to established policies and procedures.
Ability to analytically problem solve and make decisions.
Ability to tolerate and cope with ambiguity
Ability to work as a team member.
Proficiency in the use of applicable computer software.
Demonstrated ability to effectively and clearly present information through the written word, to influence or persuade others through oral presentation in positive or negative circumstances, and to listen well.
Demonstrated ability to write clearly, legibly, and effectively, to present ideas and document activities, to read and interpret written information.

Preferred Qualifications:
Recent acute care, case management, or home health experience preferred.
B.S.N. preferred.
This position is for SNF supporting the Baltimore Service Area.
Basic Qualifications:
Experience
Two (2) years of experience in acute hospital utilization review or equivalent required.
Education
N/A
License, Certification, Registration
RN License in jurisdiction where assigned required
BLS certification required.

Additional Requirements:
New Hire: Successful completion of PCC Orientation and Assessment of Critical Skills. Passing score on inter-rater reliability.
Annually: Successful completion of PCC Assessment of Critical Skills. Passing score on inter-rater reliability.
Ability to effectively communicate.
Ability to conform to established policies and procedures.
Ability to analytically problem solve and make decisions.
Ability to tolerate and cope with ambiguity
Ability to work as a team member.
Proficiency in the use of applicable computer software.
Demonstrated ability to effectively and clearly present information through the written word, to influence or persuade others through oral presentation in positive or negative circumstances, and to listen well.
Demonstrated ability to write clearly, legibly, and effectively, to present ideas and document activities, to read and interpret written information.

Preferred Qualifications:
Recent acute care, case management, or home health experience preferred.
B.S.N. preferred.
This position is for SNF supporting the Baltimore Service Area.

About Kaiser Permanente

Company Description

Serving approximately 8.7 million members in nine states and the District of Columbia, Kaiser Permanente is America's leading nonprofit integrated health plan.

Kaiser Permanente's mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve.

Our Northern California Region provides integrated health care services to approximately 3.2 million members. Approximately 4,400 physicians of The Permanente Medical Group provide services at 20 medical centers and numerous medical offices.

Company History

Founded in 1945, Kaiser Permanente is the nation’s largest not-for-profit health plan, serving more than 8.6 million members, with headquarters in Oakland, Calif. It comprises:

  1.   • Kaiser Foundation Health Plan, Inc.

  • Kaiser Foundation Hospitals and their subsidiaries

  • The Permanente Medical Groups.

At Kaiser Permanente, physicians are responsible for medical decisions. The Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible.

Kaiser Permanente’s creation resulted from the challenge of providing Americans medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Among the innovations it has brought to U.S. health care are:

  • prepaid health plans, which spread the cost to make it more affordable

  • physician group practice to maximize their abilities to care for patients

  • a focus on preventing illness as much as on caring for the sick

  • an organized delivery system, putting as many services as possible under one roof

Mission & Values

As a health care organization in the 21st century, we have a mission--to provide quality care for our members and their families, and to contribute to the well-being of our communities.

Working Here

When you bring your career to Kaiser Permanente, the work you do directly affects the health of millions. From the business people who shape our policies, to the IT professionals enabling life-saving data, to the nurses and physicians on the front line of patient care, everyone here has a role to play in the care continuum. Knowing you have a place in that process and witnessing the outcome of the work you do is empowering. It gives you a cause to stand behind. And it makes you feel proud of the work you do every day. When people witness the impact of their contributions, they excel. Together we have the power to make a difference.

Hiring Information

The first step in beginning your career search is to look for open jobs that match your skills, qualifications, and interests. Each posting includes a description of the position and the minimum required qualifications. Once you find a position you are interested in, register for an account and provide your information for consideration online.

Benefits

As an employee, you are eligible for benefits according to your full-time/part-time status and the number of hours scheduled to work per week. Benefits may vary based on your Kaiser Permanente region, position, scheduled hours, and representation by collective bargaining or employee groups, but generally include:

  • generous vacation, holiday, and sick leave

  • medical care (including prescriptions), vision, mental health, and dental care

  • disability and life insurance coverage

  • educational opportunities and tuition reimbursement

  • employee assistance programs

  • health care, dependent care, and transit spending account options

  • retirement plans

In addition, we believe in recognizing stellar performance and sponsor a variety of programs designed to reward our skilled, innovative, caring, and committed staff.

In short, at Kaiser Permanente, we understand that there is a direct correlation between happy employees and happy members. We take pride in the compassion and dedication of our employees and find many ways to reward their hard work. In return, our employees take pride in being a part of a collaborative, professional team focused on quality, service, and care.

Honors & Awards

Kaiser Permanente of Northern California has earned an "Excellent" rating from the National Committee for Quality Assurance (NCQA)-the nation's leading reviewer of health plan quality for consumers and employers. Excellent is the top rating granted by NCQA, which reviews satisfaction surveys, preventive measures, physician credentialing, member services and improvement initiatives.*

Both our Northern and Southern California regions were the only health plans in California identified by the NCQA in its list of the best health care programs in the Pacific States. (NCQA's The State of Health Care Quality 2003)

The Joint Commission on Accreditation of Healthcare Organizations accredits all Kaiser Foundation Hospitals in California.

For the seventh straight year, no other health plan has earned higher ratings from the California Cooperative Health Reporting Initiative on more measures than Kaiser Permanente. The annual ratings measure clinical quality and member satisfaction. (CCHRI Report on Quality 2003)

Our Northern California region received more three-star "Excellent" ratings than any other health plan surveyed by California's Office of the Patient Advocate on California's Quality of Care Report Card 2003-04.

* Commercial HMO and Medicare-contracted product lines: April 2003.