Case Manager Liaison Nurse - ER Discharge Planning - Olympia; St Peter Hosp - Nights

SIGN-ON BONUS OF $5,000 APPLIES TO ELIGIBLE EXTERNAL HIRES!

Variable Mon-Fri 10pm-10:30am, every other weekend rotation, alternating holidays.

MUST HAVE PRIOR ER OR CASE MANAGEMENT WORK EXPERIENCE. NIGHT SHIFT DIFFERENTIAL APPLIES!

The Care Manager will work in two 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 KFHPW 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, improve functional status and improve self‑management ability. The Liaison Nurse serves as the liaison across the internal KFHPW care continuum and between KFHPW and all externally contracted providers, facilities and resources, providing feedback to the organization regarding the service and quality of contracted services.

The Liaison Nurse collects data and provides input to leadership regarding utilization, cost, quality, service and care delivery to patients.

• Ensure patients referred to case management meet established criteria. Assess all patients to determine physical, mental, financial, psychosocial status and identify existing and potential needs. Develop patient-centered case management plans that include goals, objectives, and outcomes with specific time frames. Evaluate caregiver availability, coordinate and implement interventions using evidence‑based guidelines, recommend additional services to PCP, conduct ongoing assessment of progress, update services as needed, maintain communication with patient and care team, act as an advocate, and document all responses to interventions.

• Collaborate with health care professionals regarding plan of care, variations in implementation, achieved or expected outcomes. Monitor and evaluate short and long term patient responses, analyze patterns of variance, recommend alternative settings for care, document interventions and interactions according to KFHPW policies, and participate in measuring the effectiveness of the case management program.

• Direct and guide the plan of care to result in a seamless continuum of care. Facilitate referrals for home health care, long‑term care, hospice and other services. Participate in care conferences to problem‑solve for patients with complex needs. Collect data to evaluate effects on quality outcomes, fiscal parameters, patient satisfaction and system improvement. Understand and utilize health plan requirements and patient benefits.
  
  Assist patients in understanding and complying with their medical treatment plan and support education and activation through referrals.

• Minimum three (3) years of recent RN medical/surgical/ambulatory clinical experience.
• Minimum two (2) years of RN experience in ambulatory case management, care coordination or disease management.

• Bachelor’s degree.

• Registered Nurse License (Washington) required at hire or Compact License.
• Basic Life Support required at hire.
• Case Manager Certificate within 36 months of hire.

• Effective, independent nursing judgment and evidence‑based decision making.
• Knowledge of chronic disease process, nursing process and collaborative care planning.
• Demonstrated skill and experience in effectively collaborating with care team members.

• Minimum two (2) years of RN experience in utilization review or ambulatory case management, care coordination or disease management.
• Bachelor of Science in nursing.

• Primary
  
  Location:
  
  Washington, Olympia, Providence St. Peter Hospital.
• Sch…