Clinical Consultant
4 weeks ago
As a Regional Home Care RN Consultant at Kaiser Permanente, you will provide clinical expertise to areas of compliance involving medical necessity and quality concerns. You will utilize your clinical expertise to conduct investigations and seek input from other clinical professionals as required. Your role will involve acting as a liaison, problem-solver, and negotiator to achieve resolution on member requests and appeals.
Key Responsibilities:- Work directly with Member Services organization and other clinical and administrative leadership to investigate and facilitate resolution of complex and high-profile member requests and appeals.
- Identify gaps in clinical expertise for areas of compliance involving medical necessity and/or quality concerns.
- Utilize clinical expertise to conduct investigations and seek input from other clinical professionals as required.
- Act as a liaison, problem-solver, and project manager to close clinical, quality, educational, and compliance gaps.
- Review member complaints to identify potential quality issues that should be referred to the local Quality teams.
- Develop resources and implement solutions for all levels of Home Care staff.
- Ensure action plans are carried out, tracked, and completed.
- Provide direct support and consultation on corrective actions developed by departments for areas of non-compliance to ensure the compliance issue(s) is adequately addressed.
- Assist in the development of appropriate policies relating to compliance, clinical, and quality.
- Participate in the development and implementation of necessary educational programs to ensure all appropriate parties are knowledgeable about their compliance responsibilities on an ongoing basis.
- Minimum five (5) years of nursing staff, consultant, or management experience in ambulatory, inpatient, or care at home settings.
- Graduate of an accredited school of nursing required.
- Registered Nurse degree required.
- Registered Nurse License (California) required.
- Personal transportation required for local Service Area travel.
- May require some travel to the Service Areas and/or Regional offices across the Division.
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