Case Manager Outside Utilization RN in Downey

Full-time @Kaiser Permanente in Healthcare
  • Downey, California View on Map
  • Apply Before : September 30, 2022

Job Description

Join healthcare leader Kaiser Permanente as Case Manager Outside Utilization RN in Downey. Read role and responsibility to apply Kaiser Permanente is careers in Downey California.


Position : Case Manager Outside Utilization RN

Location :  Downey, California

Job Type : Full-time

Job details:

Description: Coordinates continuing care/outside services for continuing care members at one medical center. Repatriate stable Kaiser Permanente members from non-Kaiser Permanente facilities in the emergency department and admitted patients. The process involves screening for appropriateness of care and talking to the outside physician to establish stability to transfer to a Kaiser Permanente facility. Works with KFH and SCPMG staff in developing service plans, providing quality care, cost effective services that are aligned with federal, state and local regulations and continuing care business goals/objectives. Complies with other duties as described.

Essential 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.
Participates in committees, teams or other work projects/duties as assigned.

Basic Qualifications:



Minimum two (2) years clinical experience as an RN in Critical Care or case management required.
For positions in KP Reconnect & Transitional Care Case Management Program only (substitute first sentence above): Minimum two years clinical experience as an RN in Acute Care or case management required.
For positions in Centralized Behavioral Health Care (Psych) Utilization Mgmt: (substitute first sentence above): Minimum two years clinical experience as an RN in Acute Care Psych or psych case management required.



Please refer to Minimum Work Experience and Qualifications Sections.


License, Certification, Registration

Registered Nurse License (California)


Additional Requirements:

Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques, and methods of utilization review/management, discharge planning and case management.
Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills.
Computer literacy skills required.


Preferred Qualifications:

Bachelors degree in nursing or healthcare related field preferred.


FT position, 12 hour shift working three shifts per week for a total of 72 hours per pay period as per the Alternative Work Schedule.


Other Details

Primary Location: California,Downey,Downey Boeing – Independence Park

Scheduled Weekly Hours: 40

Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun,
Working Hours Start: 09:00 AM

Working Hours End: 09:30 PM

Job Schedule: Full-time

Job Type: Standard

Employee Status: Regular

Employee Group/Union Affiliation: B21|AFSCME|SCNSC

Job Level: Individual Contributor

Department: Independence Park – Centralized O/S Utility Mgmt – 0806

Travel: No

Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.


Career Tag :  Kaiser Permanente Jobs in Downey, Kaiser Permanente career in Downey, Kaiser health jobs in Downey, Healthcare jobs in Downey California, Jobs in Downey California, Downey jobs, Hiring nearby in Downey California

Looking to join healthcare leaders? Pharmry will help you to get Pharma jobs in Downey. Kaiser Permanente is currently looking to hire a Case Manager Outside Utilization RN in Downey California. Subscribe us to get latest job alert from us.