Exceptional Needs/ High Needs- Case Manager will provide focused assistance & support to high need KP Medicaid, Medicaid/Medicare & Charitable Program members. Enrolls special needs members into program who do not quality for other case mgmt programs or who have failed or been discharged from those programs due to their inability/unwillingness to fully participate. Provides a variety of nursing interventions, primarily by telephone & electronically, but also in person when approp & as needed to establish a relationship w/ the member. Works closely in partnership w/ the Primary Care Medical Home team including Social Work, Geriatrics & Long Term Care, behavioral health providers & other nurse coords to identify members' needs & develop a plan of care w/ patient participation. Ensures that services/interventions are well coordinated w/ no duplication of services. Works w/ non-KP providers for Mental Health, dental & other covered services. Coordination of internal & external services ensures approp access & communication. Responsible for identification & remediation of barriers to care & access that can result in population disparities.
Essential Functions:
- Provide case mgmt services for members w/ identified needs w/in the scope of the ENCC CM role by:
- Creatively using available & approp resources, including KP staff & providers, to support the unique needs of each member w/ special needs
- Facilitating access to internal & external services
- Monitoring the effectiveness of the interventions & modifying the care plan as needed w/ input from the member/family, internal & community contacts
- Reinforcing the treatment plan through lifestyle, diet, & medication compliance including support for Opiate Therapy Plan compliance
- Advising & coaching patients & families
- Identify non-medical issues; environment, abuse & neglect, homelessness & hunger & other safety concerns & work w/ state agencies & KP providers to support & remedy where possible
- Provide case mgmt & oversight to members participating in the Patient Review & Coordination Program for WA Medicaid
- Document interventions succinctly in HealthConnect & route to other providers & staff to ensure coordination of care & services
- Add relevant intervention details to the Special Populations Registry
- Manage incoming referrals to ENCC Case Mgmt; determine appropriateness to the program based on member's willingness to accept CM services, ability to interact, & current caseload restrictions as approp
- Triage findings from member assessments, identifying needs & issues & plan approp interventions
- Determine Level of Care & frequency for contact
- All ENCC CM patients require a minimum of one weekly telephone contact
- W/ the member/family & approp KP staff & providers, develop a Case Mgmt care plan that addresses short term & longer-term goals that are specific, attainable & measurable
- As a Health-Connect-based Joint Care Plan becomes available, work collaboratively w/ the Primary Care Medical Home team to develop a all-inclusive plan to communicate all aspects of need & planned services
- Work w/ PCP to ensure a clear medical treatment plan is documented
- Strengthen & update the ENCC/SNCC program through:
- Education of staff/clinicians about ENCC/SNCC & the special needs of our low income population
- Development & distribution of education, tools & materials for member coordination
- Completion of an annual program review including related policies, desk procedures, & documentation tools
- Act as a liaison between KP, other HMOs, & county & state organizations
- Actively participates in KP committees & workgroups & in county/state committee & functions
Qualifications:
Basic Qualifications:
- Two (2) or more years of direct patient care as a registered nurse.
- Bachelor of science in nursing or health related field
- RN License in Oregon & Washington. Requires Oregon or Washington license at time of hire. Licenses in both states are required within six (6) months of hire
- Current Basic Life Support (BLS) for Healthcare Providers
- Valid driver's license
- Knowledge of case management principles
- Knowledge of Oregon Health Plan, including ORS requirements, pharmacy rules and regulations and OHP list of treatable diseases
- Knowledge of community resources for the care of the disabled and elderly
- Demonstrates customer-focused service skills
- Demonstrated ability to organize, coordinate, and manage care plans
- Thorough knowledge of levels of care within outpatient, acute care, and extended care settings
- Demonstrated ability to work as part of a multidisciplinary team
- Excellent written and verbal communication skillsAbility to present reports verbally in a public setting (public speaking)
- Demonstrated data entry skills and ability to use Microsoft Word software
Preferred Qualifications:
- Prefer at least four (4) years of experience in case management, care coordination, or population care
- Prior experience serving the mentally ill and or individuals with substance abuse issues
- Prior experienced as a care coordinator or discharge planner
- Public Health Certificate
- Case Management certificate
- Knowledge of the Kaiser Permanente system, including HealthConnect
- Knowledge of Medicaid/Medicare programs and regulations
- Knowledge of quality management and utilization management principles
Salary Range:
$83,600 - $108,600
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.