Continuing Care Utilization Review Coordinator RN

Company: Kaiser Permanente Zion Medical Center
Location: San Leandro
Posted on: January 26, 2023

Job Description:

Job Summary:

Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process.

Essential Responsibilities:

• 
  
• Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after hospitalization.
  
• Conducts clinical reviews based on established treatment criteria.
  
• Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria.
  
• Reviews utilization patterns, identifies trends and problems areas for special studies.
  
• Assists in collecting and assimilating clinical data to enhance the quality of services.
  
• Generates quality improvement results.
  
• Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise.
  
• Assists other health care providers in the discharge planning process and triaging on alternative unit of care.
  
• Counsels on Medicare and health care plan coverage.
  
• Coordinates referrals to appropriate agencies/facilities.
  
• Kaiser Permanente conducts compensation reviews of positions on a routine basis. -At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. -Such changes are generally implemented only after notice is given to affected employees.
  
  
  Basic Qualifications:
  
  Experience
  
  
  • 
    
  • Minimum two (2) years of experience in an inpatient setting OR if for Skilled Nursing departments, minimum two (2) years of experience in a skilled nursing facility. -
    
  • Minimum one (1) year of utilization experience required.
    
    
    Education
    
    
    • 
      
    • Bachelors degree in nursing or health related field required, OR four (4) years of experience in a directly related field.
      
    • Graduate of accredited school of nursing.
      
    • High School Diploma or General Education Development (GED) required.
      
      
      License, Certification, Registration
      
      
      • 
        
      • Registered Nurse License (California)
        
        
        Additional Requirements:
        
        
        • 
          
        • Demonstrated knowledge of diagnostic codes.
          
        • Must be able to work in a Labor/Management Partnership environment.
          
          
          Preferred Qualifications:
          
          
          • 
            
          • Clinical expert in area of review preferred.
            
          • Masters degree preferred.
            

Keywords: Kaiser Permanente Zion Medical Center, San Leandro , Continuing Care Utilization Review Coordinator RN, Healthcare , San Leandro, California