• Job Description

  Req#: 1368729
  Job Summary:
  
  Screens and evaluates appropriateness of palliative care referrals. Gathers patient and family data in preparation for the palliative care consult by the palliative care team. Coordinates palliative care consults. Assesses member palliative care needs and monitors the quality of outcomes.
  
  Essential Responsibilities:
  
  
  
  
  • Screens, assesses and prioritizes palliative care consult referrals. Schedules and plans palliative care consults for the palliative care team.
  
  
  • Clarifies eligibility status in accordance with Health Plan policies and procedures.
  
  
  • Ensures the appropriate administration of benefits by accurate interpretation and by applying the benefit within limitations, and in a manner that exhibits judgment and an understanding of issues.
  
  
  • Identifies issues, trends, and barriers that delay the patients timely transition to the next level of care and communicates this information to others.
  
  
  • Expresses opinions and uses negotiation skills to influence financial outcomes related to hospital days, alternative care and other referred services.
  
  
  • Formulates and executes plans for health care services in collaboration with HPMG.
  
  
  • Identifies appropriate referrals and resources, takes action and makes commitments to solve individual patient care management problems.
  
  
  • Develops patient care alternatives to ensure the delivery of high quality, cost effective care.
  
  
  • Participates in discharge planning.
  
  
  • Seeks clarification of incomplete or illegible records including inpatient and outpatient records and reports problems for corrective action.
  
  
  • Identifies and reports potential risk cases or situations.
  
  
  • Displays an awareness of individual rights of patients and educates the member about those rights.
  
  
  • Maintains confidentiality of patient records, information, and departmental activities involving patient information.
  
  
  • Practices within ethical and legal guidelines using established policies and procedures.
  
  
  • Functions as a liaison, problem solver, and consultant for community social services, health care agencies, providers and various Kaiser Permanente departments.
  
  
  • Provides case management, referral management, and benefit interpretation for attending physicians, service chiefs, area physician managers, and medical facility managers.
  
  
  • Works with Medical Center staff and physicians to develop appropriate plans of care for individual patients or groups of patients.
  
  
  • Assists with routine department functions. Completes departmental documentation.
  
  
  • Participates in departmental activities related to education, staff meetings, and guideline and policy development.
  
  
  • Makes recommendations on pain and symptom management to the palliative care team, HPMG, community physicians and other disciplines involved in the members care.
  
  
  • Demonstrates competency to adhere to organizational policies, procedures, and rules.
  
  
  • May perform patient care to the extent necessary to maintain clinical expertise, competency, and licensing necessary to fulfill job responsibilities and to direct the provision of care on the unit.
  
  
  • Provides direct patient care on an as needed basis. Provides services that are within scope of license and in compliance with all legal, regulatory, and policy requirements relevant to clinical role performed.
  
  
  • Incorporates the KP Nursing Vision, Model and Values throughout their Nursing Practice.
  
  

• About the company

  Providing high-quality, affordable health care services and improving the health of our members and the communities we serve.

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