RN - Liaison Nurse - Per Diem (Care Management) Remote - Must live in WA
Company: Kaiser
Location: Olympia
Posted on: March 18, 2023
Job Description:
VARIABLE DAYS -The Care Manager will work in 2 settings on a
periodic rotating schedule, planning the discharges and follow up
care for Kaiser Foundation Health Plan of Washington patients
hospitalized at a nearby network facility and carrying a case load
of patients in one of the Kaiser Foundation Health Plan of
Washington medical centers. Some weekends and holidays are
required, and scheduled days of the week are variable. Primary
responsibility is to focus on achievement of optimal patient health
care outcomes while ensuring appropriate utilization of health care
resources. Working closely with primary care teams, specialty care
teams and medical providers, the Liaison Nurse will establish a
collaborative plan of care to assure adherence to the medical plan,
improvement in functional status, and improved ability to self
manage. Serves as the liaison across the internal KFHPW care
continuum and between KFHPW and all externally contracted
providers, facilities, and resources and provides feedback to the
organization regarding the service and quality of contracted
services. The Liaison Nurse collects data and provides input to
leadership regarding issues or concerns related to utilization,
cost, quality, service and care delivery to patients.Essential
Responsibilities:
- Ensures patients referred to case management meet established
case management criteria.
- Assess all patients referred for case management to determine
physical, mental, financial, psychosocial status, utilizing
comprehensive, standardized criteria to identify existing and
potential needs.
- Develop patient centered case management plan based on
assessments and including patient goals, objectives, and outcomes
with specific time frames (long/short term).
- Evaluate ability and availability of designated caregiver(s) to
provide patient support.
- Coordinate and implement interventions using evidence based
guidelines.
- Recommend additional services to PCP as determined in the case
management plan.
- Conduct ongoing assessment of progress against original
goals.
- Continuously update needed services.
- Maintain ongoing communication with patient/family and care
team.
- Acts as an advocate for patient care needs.
- Documents all responses of patient to case management
interventions.
- Collaborates with other health care professionals regarding the
plan of care, variances in plan implementation, achieved outcomes
or expected outcomes.
- Monitor and evaluate short and long term patient responses to
therapeutic interventions and analyze patterns of variance from
clinical information and outcomes.
- Recommend alternative settings for care based on health care
needs and appropriate utilization of health care resources.
- Document interventions and interactions with patients or
caregivers according to GH and Care Management policy and
procedure.
- Participate in the measurement of the effectiveness of the case
management program.
- Directs and guides the plan of care to result in a seamless
continuum of care.
- Facilitates as needed, referrals for home health care, long
term care, hospice, and other care facilities or services.
- Participation in care conferences to provide problem solving
for patients with complex care needs (limited basis).
- Collects needed data needed to evaluate the effects of care
coordination on quality outcomes, fiscal parameters, patient
satisfaction and systems improvement.
- Understands and utilizes health plan requirements and patient
benefits in making care management decisions.
- Assists patient to understand and comply with their medical
treatment plan.
- Supports patient education and activation through referral to
specific chronic illness classes, group visits or community
resources.Basic Qualifications: -Experience
- Minimum three (3) years of recent RN
medical/surgical/ambulatory clinical experience required.
- Minimum two (2) years of RN experience in ambulatory case
management, care coordination or disease management. -Education
- Bachelor of science degree. -License, Certification,
Registration
- Case Manager Certificate within 24 months of hire
- Basic Life Support required at hire
- Registered Nurse License (Washington) required at hire
-Additional Requirements:
- Demonstrated skill and experience in effectively collaborating
with care team members.
- Knowledge in management of chronic disease process, nursing
process and collaborative care planning.
- Effective, independent nursing judgment and skills, and use of
evidence based clinical decision making criteria. -Preferred
Qualifications:
- Bachelor of science in nursing.Job Schedule: Job Category:
Nursing Licensed & Nurse Practitioners
Keywords: Kaiser, Olympia , RN - Liaison Nurse - Per Diem (Care Management) Remote - Must live in WA, Executive , Olympia, Washington
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