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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

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