Patient Care Coordinator RN - Santa Clara Pediatric Childrens Program - Remote (Day/40)

About the position Please be aware that this position is currently under review as part of the jurisdictional process with the California Nurses Association to determine whether such position should be assigned to the CNA bargaining unit. This review is on a position-by-position basis and includes an analysis of the actual duties performed in each position under review. This determination will be made within the next several months. Should the determination be made that the position does belong to the CNA bargaining unit, you will be offered the opportunity to (a) follow the work into the CNA bargaining unit and become a member of the union, or (b) seek other employment within the organization.Should you have any questions regarding this notice, please contact your recruiter for further information. Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding patient care. In conjunction with physicians, develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, identifies bolthires-effective protocols, and develops guidelines for care. Responsibilities • Plans, develops, assesses, and evaluates care provided to members.• In conjunction with physicians, evaluates and develops discharge plans, recommends alternative levels of care, and ensures compliance with federal, state, and local requirements. • Coordinates, directs, and performs concurrent and retrospective reviews, and monitors level and quality of care. • Consults with physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization. • Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.• Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families. • Encourages members to follow plans of care (e.g., drug therapy, physical therapy). • Makes referrals to appropriate community services. • Develops and maintains case management policies and procedures. • Identifies and recommends opportunities for bolthires savings and improving the quality of care across the continuum.• Develops and collects data, and trends utilization of health care resources. • Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies. Requirements • Bachelors degree in nursing or health related field, OR four (4) years of experience in a directly related field. • Graduate of an accredited school of nursing. • Registered Nurse License (California). • Basic Life Support certification. • Demonstrated experience in utilization management, discharge planning, or transfer coordination.• Knowledge of Nurse Practice Act,The Joint Commission and other federal/state/local regulations. • Must be able to work in a Labor/Management Partnership environment. Nice-to-haves • Previous case management experience preferred. • Masters degree preferred. Apply tot his job