RN Weekend Coordinator- Homecare Specialist

4 weeks ago

Atlanta, Georgia, United States Kaiser Permanente Full time
Job Summary:

As a RN Weekend Coordinator- Homecare Specialist at Kaiser Permanente, you will play a critical role in ensuring the highest quality of care for our patients. Your primary responsibility will be to conduct utilization reviews, quality reviews, and discharge planning for inpatient admissions at facilities without QRM review staff onsite. This will involve telephonic initial admission and concurrent review for inpatient admissions, discharge planning, identification of patients for case management, communication with case managers, home care reviewers, Social Workers, providers, and members as indicated, quality improvement reviews, and education of the member/family, provider, and hospital staff.

Achieving desired utilization and quality outcomes while promoting high customer satisfaction is essential to this role. You will work closely with multidisciplinary teams to handle complicated cases, understand complex and transitional case management and specialty care programs, and refer patients to the Case Managers and specialty care programs as appropriate.

Key Responsibilities:
  • Conduct day-to-day inpatient review activities, utilizing established criteria to perform prospective, concurrent, and retrospective utilization review for all members requiring inpatient admission.
  • Review all new inpatient admissions within 24 hours and begin the discharge planning process immediately.
  • Monitor and review all inpatients at a minimum of every 3 days and more frequently as appropriate based on criteria and policy.
  • Coordinate case conferences involving multidisciplinary teams to handle complicated cases.
  • Interact with physicians to ensure that resources are being utilized appropriately while maintaining quality outcomes.
  • Establish and maintain contact with patients and their families as appropriate, including the provision of education when needed.
  • Document review activities, including medical necessity for admission, medical necessity for continued stay, estimated length of stay, diagnoses, procedures performed, demographic data, discharge planning, physicians involved in care, and other relevant information.
  • Issue letters of non-coverage to members not meeting inpatient level of care criteria per established criteria and policy.

This role requires strong communication and interpersonal skills, as well as the ability to work effectively in a fast-paced environment. If you are a motivated and detail-oriented individual who is passionate about delivering high-quality care, we encourage you to apply for this exciting opportunity.

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