Regional Home Care RN Specialist

3 weeks ago


Pasadena, California, United States Kaiser Permanente Full time
Job Summary

As a Regional Home Care RN Consultant, you will provide clinical expertise to ensure compliance with medical necessity and quality concerns. You will work closely with Member Services, clinical, and administrative leaders to investigate and resolve complex member requests and appeals.

Key Responsibilities
  • Collaborate with Member Services and clinical leaders to investigate and resolve member requests and appeals.
  • Identify gaps in clinical expertise and develop resources to address them.
  • Conduct investigations and seek input from other clinical professionals as needed.
  • Act as a liaison, problem-solver, and project manager to close clinical, quality, and compliance gaps.
  • Review member complaints and identify potential quality issues.
  • Develop and implement solutions for Home Care staff to ensure compliance with policies and procedures.
  • Provide direct support and consultation on corrective actions for non-compliance issues.
  • Assist in developing policies and procedures related to compliance, clinical, and quality.
  • Participate in the development and implementation of educational programs to ensure compliance responsibilities are understood.
  • Lead high-visibility projects to identify and resolve strategic issues in Home Care.
Requirements
  • Minimum 5 years of nursing 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.
  • Excellent interpersonal, verbal, and written communication skills.
  • Ability to work in a Labor/Management Partnership environment.


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